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Keyworth study of whooping cough
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Sufferers' comments and experiences
Babies under 4 months old are the individuals at serious risk of dying from whooping cough. It can be prevented by a booster immunization in later pregnancy. Those who are not protected in this way and are unfortunate enough to get it need critical care in hospital. Recent research in the USA has provided evidence that exchange transfusion in the early stages improves the outcome. The use of steroids has been associated with a worse outcome.
James D. Cherry (2019) The prevention of severe pertussis and pertussis deaths in young infants, Expert Review of Vaccines, DOI: 10.1080/14760584.2019.1581065
This is hardly news but I have put on a graph the incidence of adults (15 years and older in this instance) with whooping cough in Keyworth. Official figures of national trends often appear to show it is only recently that adults have started to get the disease. This is not so, but is the result of different recording and detecting methods. The graph speaks for itself. To see in full detail use this link
There is a lot going on researchwise and it is all focussed on finding a better vaccine. For a decade or so it has been possible to examine the genetic make-up of Bordetella species and it has shed light on the disease in a new way that helps to explain it better. It had also been found that baboons are susceptible in a similar way to humans which allows easier testing of new theories. We now know for sure that you can get infected without getting symptoms and that immunity can also be boosted that way. Immunisation prevents the disease better than it prevents infection. Many people get infection and some immunity without symptoms that are characteristic of whooping cough, particularly young adults. Why some get fully blown symptoms and not others is not known. Why those with mild symptoms do not seem to transmit the severe disease is unknown. Baboon experiments have shown that it is transmitted by airborn droplets, and human experiments have shown that you need to inhale 100,000 colony forming units to infect a healthy adult. Tying all this in with antibody responses and purified vaccine elements is really very compex but slowly getting sorted.
What all this tells us is that giving adult booster shots of acellular vaccine every 10 years may not be effective, as it only has preventive power for about 2 years. To be sustained it would need boosting every 3 years and that is not possible under current licencing. It is still worthwhile however, because even if it has worn off you get a milder dose that if you had not been immunised.
The 2016 Pertussis figures for England were published on 24th March. The total was 5945 laboratory confirmed cases. 2016 was expected to show a rise above baseline as pertussis cycles about every 4 years. 2012 was a really big year with nearly 10,000 cases, and I think many experts, myself included, thought 2016 might be even bigger. Thankfully it has not turned out that way, but it has to be said that we are a very long way from understanding the factors that determine the variation from year to year. The one striking statistic that comes out of the figures is the reduced incidence in babies under 3 months old. This is a result of giving pertussis boosters in pregnancy, an unusual but brilliant policy that has undoubtedly saved many lives.
There was no large rise last winter although the number of confirmed cases went up. Numbers are now rising more quickly and this site is getting more hits. This probably indicates this winter might see a big rise in cases. The message is very clear. Make sure you are up to date with your shots, especially children, and if you are pregnant get your booster in good time.
The last big whooping cough year in the UK was 2012 and since whooping cough cycles every 4 to 5 years, 2016 could possibly be the next
big year. Some clue may come from the number of visits this site gets. There were 536,000 visits in the last 12 months. There is no sign of an upsurge yet. The big message is still GET A BOOSTER WHEN YOU ARE PREGNANT. That could reduce deaths by at least 80%!
The final total of laboratory confirmed cases in England and Wales in 2014 was 3388. Most cases were in adults. A Public Health England report recently published gave a detailed insight into the pattern of cases over the last few years. Most cases were in 2012, so given the 4 yearly cycle next year may see a rise. The most important action is to raise the immunization rate in pregnant women, as this looks like the most effective way of preventing deaths from pertussis.
December 28th 2014
Press comments currently reporting article in Journal of Infectious diseases that says the whooping cough bacterium is changing as a result of the vaccine.
No surprise here. Of course it will change; that is natural selection at work. In recent years we have developed the technology to measure such things.
What the news reports don't point out is that the bug is changing because the vaccine is killing it! That is the point of the vaccine. And it is very effective.
There are several components in the current vaccines used, and the implication is that these components may need adjusting as the bug adjusts. Not too difficult these days.
There was a total of 4623 cases in 2013 compared with 9741 1n 2012. The numbers for 2014 are lower so far than in 2013. Only 60% of pregnant women are being immunised. This is a very effective protection measure. Since it was introduced in England and Wales there have been 9 deaths in babies under 6 months from pertussis. The mother had not been immunised in 8 of these cases. Protection is probably 90%.
The full numbers for 2013 in the UK are not yet available but have steadily fallen after the 2012 peak. Public Health England, the body collecting the data, are indicating more strongly than before that increased "ascertainment" accounts for an unknown proportion of the increased numbers. Ascertainment seems to be another word for confirmed diagnosis.
June 26th 2013
The number of cases in England Wales has been declining since last October
with 434 reported in March 2013. This is still a highish level, so it is going to be around for a while. The number of emails I am getting has dropped off very dramatically and the number of hits is dropping to just under 2,000 a day. This would be consistent with a decline in cases in the UK, USA and Australia. It appears to me that the increase in cases of the last year or two has similar timing in these three areas, something I have not observed before. I think a large proportion of the increase is the result of improved testing done more readily, at a time of higher incidence.
March 15th 2013
The UK Health Protection Agency has announced it will now test oral fluid specimens for pertussis in 8 to 16 year olds suspected to have pertussis. This can be done after 2 weeks of illness and provides an easy alternative to blood testing which patients in this age group are likely to decline. This age group is key in the understanding of pertussis and its possibly changing pattern of attack.
6th February 2013
The total cases in England and Wales in 2012 was 9,741 with 14 deaths. The highest attack RATE is in the under one year olds but the greatest NUMBERS are in the over 15s by far. The increased numbers in infants, when pertussis is least likely to be missed as a diagnosis may reflect the fact that parents of childbearing age are now increasingly susceptible and possible passing it to their infants. The death rate in infants is about twice the expected number and is cause for concern as the purpose of immunisation is in the main to stop infants dying or being damaged. The bottom line is that there is something going on to put infants at greater risk, and it needs to be investigated and remedied.
In Keyworth the total number of cases was 22 for the year. The average age was 34! No babies were affected. Ages ranges from 6 to 81. More than half of them "whooped", and half experienced apnoea. This is contrary to what is being said by some authoritative sources who say that the disease is milder in adults than in children. There is no evidence of that in the Keyworth Study.
12th January 2013
It looks as if it is all slowing down now. The total for Keyworth in 2012 is going to be about 19. No different from previous epidemic years. This supports the hypothesis that there has been NO real increase.
The total confirmed cases for England and Wales for 2012 is going to be about 10000. That is about one person in 5000. Keyworth practice has about 11,000 patients and 22 cases. That is one in 500. Ten times the national rate. It makes nonsense of trying to extrapolate anything from official figures.
9th November 2012
The Keyworth count has gone up to about 12. This does NOT reflect the supposed great increase. The last big number in Keyworth was 10 in 2006. Before that in was 44 in 2002.
The pregnant are now advised to get a booster (or first dose) of whooping cough vaccine between 28 and 38 weeks. This is said to give the baby some immunity before the infant gets immunised at 2 months. This sounds really good and important. It must be based on new evidence. I am eagerly waiting to read this evidence. Anybody know about it?
21st September 2012
A recent count-up of cases in Keyworth this year shows about 7 confirmations. It is too early to reach conclusions, but it looks average so far. That is to say, we have not seen the great increase we would expect if it were REALLY getting more common.
21st August 2012
I have published a letter in the British Medical Journal this week pointing out some of what is above. To see the article follow this link
27th July 2012
The news is currently full of reports that whooping cough in the USA is the worst outbreak since the 1950s. (It was roughly in the 1950's that whooping cough vaccine was introduced).
The Health Protection Agency (for England and Wales) is telling us that the number of cases is much higher this year than 4 years ago at the peak of the last upsurge. (whooping cough tends to cycle every 4 years). This body, which the official government body for these matters, has just started recommending that medical staff whose job brings them in contact with young babies should get a pertussis booster shot.
The story is similar in Australia.
I am watching the number of cases in the Keyworth practice (from which all my data are obtained) to see if there a similar large increase in numbers. So far, and things could easily change, there has not been a change in the pattern that I have been been observing for the last 20 years. (Most cases in adults, and 50 times as common as official figures)
In other words, the increased numbers are possibly a result of it being recognised more, as a result of better information (this website for example), and better diagnostic testing (a blood test which can show positive after 2 weeks has replaced a nose swab test, which was usually negative by the time whooping cough was suspected).
A few journalists are taking me seriously, which is nice.
I also know that the UK is considering adding pertussis to the school leaving booster, something that some other countries are already doing, although strong evidence of benefit may be lacking. Offering it to prospective parents similarly seems to make good sense. Numerical evidence of an increasing pertussis problem will help to make these changes acceptable if they come about.