NATURAL COURSE OF 500 CONSECUTIVE CASES OF WHOOPING-COUGH - A GENERAL-PRACTICE POPULATION STUDY

Objective-To describe the natural course of whooping cough. Design-Observational study of a general practice population. Setting-Discrete semirural East Midlands practice of 11 500 patients. Subjects-500 consecutive cases of whooping cough diagnosed clinically during 1977-92. Main outcome measures-Incidence of vomiting, whooping, apnoea, admission to hospital, and complications; duration and frequency of paroxysms. Pattern of spread. Results-The incidence in the practice population was 4347/100 000 population compared with a notification rate for England and Wales of 717/100 000. Most cases were relatively mild. 284 patients vomited after paroxysms, 242 whooped, and 57 had apnoea. Duration and frequency of paroxysms varied widely. Female and unimmunised patients suffered more severe disease. Bordetella was isolated from fewer immunised patients (24/96 v 63/122 unimmunised). Infection was usually spread through contacts with someone with clinical whooping cough. Five patients developed pneumonia, three of whom had been immunised. Three patients required hospital admission. Conclusions-Most cases of whooping cough are relatively mild. Such cases are difficult to diagnose without a high index of suspicion because doctors are unlikely to hear the characteristic cough, which may be the only symptom. Parents can be reassured that a serious outcome is unlikely. Adults also get whooping cough, especially from their children, and get the same symptoms as children. The difficulty of early diagnosis and probability of missed cases reinforces the need to keep the incidence low through immunisation in order to protect infants, who are the most vulnerable.