Pertussis test advised in all four-week coughs
By Emma Wilkinson
GPs should test for whooping cough in all children and adolescents with a cough lasting more than four weeks, even if they have been vaccinated against the disease, a new study concludes.
As many as 37 per cent of children whose cough had lasted for 14 days or longer had evidence of recent infection with Bordetella pertussis, even though 86 per cent had been fully immunised as babies.
Children were particularly likely to have pertussis infection if they were whooping, vomiting or producing sputum (see box).
The researchers said securing a more precise diagnosis for chronic cough would spare children inappropriate treatment and allow GPs to give parents more precise information about prognosis.
Study leader Dr Anthony Harnden, a lecturer in the department of primary health care at the University of Oxford and a GP in the city, said whooping cough had fallen off GPs' radar because of the immunisation programme.
He said: 'If children have been coughing for longer than four weeks, GPs should be thinking of testing and if there are vulnerable children in the household maybe a diagnosis should be secured earlier.'
The findings also raise questions over the effectiveness of the immunisation programme – and whether a booster might be required in adolescence.
Dr Natasha Crowcroft, consultant epidemiologist at the Health Protection Agency, said the agency was currently modelling the effect of introducing a booster in teenagers.
'There are still lots of
questions to be answered. This study really justifies the introduction of the preschool booster – it shows we did the right thing.'
The researchers, whose study was published online by the BMJ, examined data on 172 children aged five to 16 who presented to their GP with a cough lasting 14 days or longer.