Natural course of 500 consecutive cases of whooping cough: a general practice population study.
OBJECTIVE
To describe the natural course of whooping cough.


METHODS
Observational study of a general practice population.


METHODS
Discrete semirural East Midlands practice of 11,500 patients.


METHODS
500 consecutive cases of whooping cough diagnosed clinically during 1977-92.


METHODS
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.
Jenkinson
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Keyworth Health Centre, Nottingham.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001049:Apnea / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D005194:Family Practice; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D013997:Time Factors; D014917:Whooping Cough / Q000150:complications / Q000453:epidemiology / Q000635:transmission