title: Whooping cough in school age children presenting with persistent cough in UK primary care after introduction of the preschool pertussis booster vaccination: prospective cohort study.
abstract: OBJECTIVE
  To estimate the prevalence and clinical severity of whooping cough (pertussis) in school age children presenting with persistent cough in primary care since the introduction and implementation of the preschool pertussis booster vaccination.
  
  
  METHODS
  Prospective cohort study (November 2010 to December 2012).
  
  
  METHODS
  General practices in Thames Valley, UK.
  
  
  METHODS
  279 children aged 5 to 15 years who presented in primary care with a persistent cough of two to eight weeks' duration. Exclusion criteria were cough likely to be caused by a serious underlying medical condition, known immunodeficiency or immunocompromise, participation in another clinical research study, and preschool pertussis booster vaccination received less than one year previously.
  
  
  METHODS
  Evidence of recent pertussis infection based on an oral fluid anti-pertussis toxin IgG titre of at least 70 arbitrary units. Cough frequency was measured in six children with laboratory confirmed pertussis.
  
  
  RESULTS
  56 (20%, 95% confidence interval 16% to 25%) children had evidence of recent pertussis infection, including 39 (18%, 13% to 24%) of 215 children who had been fully vaccinated. The risk of pertussis was more than three times higher (21/53; 40%, 26% to 54%) in children who had received the preschool pertussis booster vaccination seven years or more previously than in those who had received it less than seven years previously (20/171; 12%, 7% to 17%). The risk of pertussis was similar between children who received five and three component preschool pertussis booster vaccines (risk ratio for five component vaccine 1.14, 0.64 to 2.03). Four of six children in whom cough frequency was measured coughed more than 400 times in 24 hours.
  
  
  CONCLUSIONS
  Pertussis can still be found in a fifth of school age children who present in primary care with persistent cough and can cause clinically significant cough in fully vaccinated children. These findings will help to inform consideration of the need for an adolescent pertussis booster vaccination in the United Kingdom.
  
  
  BACKGROUND
  UK Clinical Research Network portfolio ID 8361.
authors: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK kay.wang@phc.ox.ac.uk.
authors: Kay
authors: K
authors: Wang
authors: Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, 61 Colindale Avenue, London NW9 5HT, UK.
authors: Norman K
authors: NK
authors: Fry
authors: Immunisation, Hepatitis and Blood Safety Department, Public Health England.
authors: Helen
authors: H
authors: Campbell
authors: Immunisation, Hepatitis and Blood Safety Department, Public Health England.
authors: Gayatri
authors: G
authors: Amirthalingam
authors: Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, 61 Colindale Avenue, London NW9 5HT, UK.
authors: Timothy G
authors: TG
authors: Harrison
authors: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
authors: David
authors: D
authors: Mant
authors: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
authors: Anthony
authors: A
authors: Harnden
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003371:Cough / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D007117:Immunization, Secondary; D008297:Male; D010567:Pertussis Vaccine / Q000008:administration & dosage*; D015995:Prevalence; D011320:Primary Health Care; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology; D014917:Whooping Cough / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D010567:Pertussis Vaccine