By Kennedy Gosnell
Whooping cough does not typically result in death. Most deaths accredited to whooping cough are due to complications that result from the infection, but not from the disease itself. These complications include hernias, pneumonia, seizures, brain damage, dehydration, and death. As with many other diseases, children under 12 months are at the greatest risk of developing complications and dying. Before whooping cough vaccinations became routine in the United Kingdom in 1957, whooping cough was considered a major childhood disease that affected over 100,000 people yearly in the United Kingdom alone. Whooping cough often resulted in many long term effects and complications, including asthma.
Whooping cough is a cyclical disease that occurred periodically every 3 to 5 years in both pre-vaccine and vaccination eras. The intensity of the cycles varied due to demographic differences, vaccine coverage, differences in the surveillance of the disease, and biological changes in the circulating bacteria. Cyclical prevalence of the disease can be analyzed utilizing the Medical Officer of Health Reports, and with this the mortality can be examined.
Mortality in the 19th Century
While whooping cough rarely results in fatality today, that was not the case in the 1800s. Whooping cough was especially dangerous for infants and young children. For example, in 1876, the total mortality in England due to whooping cough was 10,206. Of this, 43% of the deaths were children under 12 months of age. In MOH Islington 1861, 209 children died from whooping cough and 132 were under the age of 2. Additionally, whooping cough was especially fatal for families who lived in the poorest of areas, indicating a correlation between living conditions and disease mortality. The MOH London County Council 1909 reported that “the incidence of whooping-cough mortality progressively increases from the least to the most overcrowded groups of districts.” The dangers of whooping cough were so prevalent that among zymotic diseases it was the most deadly: there were 82 deaths in MOH Kensington 1886. Incidences of diseases, including whooping cough, were noted long ago as being contingent on both weather and lifestyle.
In the cities, towns, and villages in Europe, children suffer much from cold, and uncomfortable schoolhouses; and are visited, now and them, with mortal disorders in consequence. But in New-England, school-houses are abodes of warmth and comfort in winter, and perfectly ventilated in summer, calculated to please its little inhabitants; and we very seldom, if ever, hear of any serious disease infesting any of those numerous establishments.Waterhouse, 1822
Mortality in the Early 20th Century
Jules Bordet and Octave Gengou determined the causative agent of whooping cough to be Bordetella pertussis in 1906. With this discovery, they were able to develop a vaccine. Unfortunately, there was much hesitation with the pertussis vaccine and it wasn’t introduced as a routine vaccine until 1957. In 1908 there were 39 deaths from whooping cough in Hackney, and 14 of these deaths were in children under the age of one. A study looked at the death rates (per million persons) in people aged 1-5 from 1914 to 1942. Through analyzing health reports in England and Wales, it was concluded that mortality from whooping cough, bronchitis, and pneumonia was high during similar years, indicating that the diseases were more deadly during similar conditions. The three diseases had significant peaks of mortality during 1918, 1922, and 1929. MOH Paddington 1909 reported that increased mortality from bronchitis and pneumonia was always noted when prevalence of whooping cough and measles were high.
The cyclical nature of the disease is also evident in reports from MOH Surbiton 1952. From 1943 – 1952 the cases of whooping cough varied from 48 to 204, changing every year. There were, however, no deaths reported.
A study conducted at the University of California in 1922 analyzed death rates from whooping cough from 1890 – 1918; it was found that the ratio of female to male deaths in all age categories ranged from 107:1 to 158:1, indicating that females were much more likely to die from whooping cough. This data is consistent with the mortality rates in the UK; MOH Paddington 1913 reported that females had higher mortality rates from whooping cough, measles, diphtheria, and “other causes.” Researchers have not been able to pinpoint the exact reason why females have higher mortality rates, but it is suggested that it could be related to differences in the laryngeal apparatus between the two sexes.
Mortality in the Middle to Late 20th Century
Just a couple of years before routine vaccination, the cyclical outbreaks were still common and prevalent. MOH Islington 1953 reported that there were 564 notifications of whooping cough in 1952, but in 1953 there were 1,188 notifications. Of this, 64% of the cases were in children under the age of 5; fortunately there were only 2 reported deaths.
The Vaccine Knowledge Project from the University of Oxford reported that before vaccination, the average number of cases of whooping cough in England and Wales was over 100,000 each year, sometimes resulting in over 2,000 deaths. By 1972, when over 80% of children were vaccinated, this had fallen to 2,069 suspected cases and 2 deaths.In 1957 the United Kingdom introduced routine infant pertussis immunization with a whole-cell pertussis (wP) vaccine. Unsurprisingly, after this implementation there was a reduction in pertussis cases and resulting deaths. In Islington there were only 69 incidences of whooping cough in 1961, which was just four years after the introduction of routine vaccinations, with no resulting deaths. Additionally, there were only 39 cases of whooping cough in Walthamstow in 1962.
As with diphtheria (no cases) and whooping coughMOH Walthamstow 1962
(39 cases only) immunisation was proving its value and through
constant vigilance and the prompt application of established methods
of control infectious disease had largely ceased to be a problem.
However, the reductions in mortality from whooping cough did not last forever. In 1974 there was an outbreak of whooping cough in England in a population where 80% of the people had been vaccinated against whooping cough. This resulted in a decline in vaccination rates, and only 3 out of every 10 children were vaccinated against pertussis in 1975. Unsurprisingly, there were whooping cough epidemics in the late 70’s and early 80’s. Fortunately by 1993 the vaccination rate had recovered to about 94%.
From London’s Pulse: Medical Officer of Health reports 1848-1972)
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