Much of the information on this website is based on the study of whooping cough that I undertook as a family doctor over 40 years in Keyworth. Much of the material has been published in medical journals. Some is unpublished, and some is my opinion based on experience. I believe this is a unique study and that I have a contribution to make to the understanding of this unpleasant and sometimes lethal disease.

I wish to make my data available to the public so they may judge its value for themselves. This page outlines the main findings. 

Keyworth is a village about 5 miles south of Nottingham in the East Midlands of England. It has a population of 8,000. There are several smaller nearby villages and all together make up a community of about 11,000, that all come under the care of 8 family doctors working from a single medical centre (30 years ago there were 11,800 patients and 4 doctors).

I started working at Keyworth Health Centre in 1974, when I was the most junior partner after returning from 3 years in central Africa where my research interests developed. Since 1977 I have made a special study of whooping cough in this small population (744 cases).  I have developed the ability to recognise cases that most other doctors would miss, simply because of my intense interest in this disease and being on the lookout for it all the time. Because of the way healthcare is organized in England, with single medical records and patients registering with one medical centre only, it is possible for me to be confident that what I observe about whooping cough in Keyworth, is as complete as possible, accurate, and most of all, consistent. 

I retired from the partnership in 2011 but was able to reliably follow the incidence until the end of 2013. Since then it has not been possible to continue the study with the previous thoroughness and therefore the study officially ended then. 

It has become even more important to continue in the same way because serological diagnosis has become mandatory as the UK Health Protection Agency now uses laboratory confirmed cases for its statistical baseline. As the age of victims has climbed to an adult age, so the ease of getting a blood test increases. Blood tests have only been available since 2002 in the UK and only widely used since 2006. Increasing familiarity with the need for the test and increased awareness and self diagnosis by the now adult victims by means of the internet (and previously this site in particular), has led to a large rise in the proportion of suspected cases that are getting confirmed, and the number of tests being done. Previously they would not have been tested at all, or by pernasal swab which is difficult to arrange and uncomfortable, as well as usually being negative because it was too late in the illness. So they would hardly ever be notified. 

Because we were just an average medical practice, what I have observed in Keyworth is also probably representative of what happens in the rest of the United Kingdom. It may also be quite similar to what happens in other developed countries with similar immunization practices (for example: USA, Canada, Australia, New Zealand and the countries of the European Union).

What have I concluded?
Whooping cough has been to a great extent ignored and forgotten for half a century or more, because immunization has been so successful at reducing the number of cases of the disease. It did, however, not completely go away, and people are now realising that it is still about and causing quite a lot of trouble. Some people think it is making a comeback. It is doubtful if this is true if the Keyworth data are correct. They seem to indicate that the amount of trouble whooping cough has been causing has been much the same for 30 years, although there are some quite interesting changes in the ages of people it attacks.

Why is this relevant? 
There is currently discussion in the media about whooping cough making a comeback, particularly in adults. I think much of this is apparent rather than real. Recent research has shown that many adults with persistent coughs do indeed have whooping cough. This is not new information if the Keyworth study is representative. Looking for it is what is new. The Keyworth data show that the incidence in adults has remained constant since 1986, and it is the others that have fallen. 

Since immunization came in the 1950s, doctors have seen less and less whooping cough and modern doctors may never have seen a case, let alone heard the cough.  I believe that much of the drop in notifications  has simply been a reflection of the poorer diagnostic skills of modern doctors in respect to whooping cough. Now that some people are looking for it with more sophisticated tests such as PCR, blood antibody, and recently oral fluid antibody tests, they are finding it, but notifications are still low, as the average doctor is still reluctant to diagnose it. This changing however and an apparent resurgence in the USA, Australia and the UK in 2011-12 or thereabouts has raised the numbers notified in these countries, and the numbers have only dropped a little since then. Most of this is in my view due to increased recognition but some of it may be due to acellular vaccine performing poorly compared with the older one which came into use around the millennium.

There is a a new factor operating now that is likely to further inflate the pertussis statistics in developed countries. That is the practice of using PCR for primary diagnosis. This test is positive in the early stages of infection irrespective of whether it develops into clinical whooping cough.  Early and sensible testing of contacts of index cases in order to manage the infection better (with prophylactic antibiotics for example), will identify infections that would never previously have been even suspected. 

There are now  inexpensive PCR point of care tests available for B. pertussis.

If the numbers recorded are to be interpreted accurately there is a need to record clinical whooping cough separately from B. pertussis infection.

Raw data (anonymous) from this Keyworth study along with tables and graphs can be made available on email request in order that health care workers, epidemiologists and interested others can study the detail.