There’s nothing new about whooping cough. The recent press coverage of the present whooping cough mini-epidemic takes me back to the 1980s when I first became a GP.
I joined my practice in 1985 at a time when immunisations were done either by the GP or by the ‘clinic doctor’ who would nowadays be called a community paediatrician. A routine course of baby ‘jabs’ consisted of three injections and three lots of polio drops in the mouth between three and 10 months of age. From memory the uptake of diphtheria, tetanus and polio was in the 90-95% range with whooping cough uptake lagging behind by about 10% – mean that it wasn’t high enough to ensure ‘herd’ immunity.
My practice did not have a practice nurse so the jabs had to be done by the GP. Some parents were happy to see their baby immunised, others were more reluctant, particularly in relation to the whooping cough component of the ‘triple jab’ which at the time was widely thought to carry a small risk of causing brain damage. My job was not made easier by the local MP who was a well respected campaigner for the rights of the deaf and disabled who also lent his support to a campaign by parents who thought that their children had been damaged by the whooping cough immunisation.
On the positive side I was a new young local GP who had decided to live in the practice area. I was happy to explain to other parents that my own children had been immunised against ‘everything’. I did not make Tony Blair’s mistake of hiding behind confidentiality in relation to his own children when similar worries and concerns arose about the MMR immunisation in later years.
Whooping cough itself was a condition which I saw quite frequently, but was mostly diagnosed when the child had already developed the characteristic ‘whoop’ by which time there was usually nothing much to be done in the way of treatment. The diagnosis generally required the doctor to hear the child coughing in surgery.
Sometimes the diagnosis was made with the assistance of a pernasal swab which was passed through the bottom of the nose and which would sometimes produce a similar reaction in the child to that which occurs when I take my dog to the vet for his annual ‘kennel cough’ drops which my veterinary colleague has the pleasure of squirting into his nose.
Occasionally I would also ask a parent to make a cassette recording of their child’s cough to bring back to me to listen to which would also help to ‘nail’ the diagnosis before making a notification to Public Health.
Very occasionally I would also use the tape recording of somebody’s child with whooping cough to play out loud to a parent who was still in two minds about immunisation. I’m not sure where I would now stand confidentiality-wise, although I still have the tape in my possession and the patient herself is now in her 20s.
Of the patients whom I treated for whooping cough most made a good recovery. Some ended up in hospital, in particular babies and infants.
However a few cases do spring to mind. My stepson is now in his 20’s but had the misfortune to develop whooping cough at age 6 weeks, before he was old enough to be jabbed, presumably infected by somebody else’s child who should have been immunised.
Another patient of mind was not immunised against whooping cough at her mother’s request. In later years she became a mother herself and I can remember her making an appointment to see me to ask if her own baby could be ‘jabbed’ against whooping cough earlier than the usual age of eight weeks. She told me that one of her first memories was of being off nursery (or school) with whooping cough, and went on to describe her abiding memory of her mother following her around with a bucket of disinfectant to clean up on those occasions when her cough also caused her to vomit. She didn’t want her own child to suffer in the same way.
Which brings me back to a possible connection between then and now. Is the present mini-epidemic of whooping cough arising from a generation of parents who were themselves children in the 1980s, but who were not immunised then?
Either way it’s a real shame that the midwifery community now can’t find the time or resources to immunise expectant mums when the opportunity arises – instead the patient has to make a separate appointment to see one of the practice nurses, who are already busy enough doing the routine baby jabs.
Dr Glyn Bennett is a GP partner in Werrington, Stoke On Trent.