The whooping-cough immunisation controversy.

Few subjects in child health have caused so much uncertainty and controversy in recent years as whooping-cough immunisation, its benefits and its dangers. A set of reports' from the Committee on the Safety of Medicines and the Joint Committee on Vaccination and Immunisation (JCVI) give the best information so far on this difficult subject, and provide definite answers to at least some of the questions. In summary, they show firstly beyond reasonable doubt that in the few days after pertussis immunisation a child is more likely than at other times to develop an acute neurological illness which may leave permanent neurological handicap, However, this complication of pertussis immunisation is rare, and most acute neurological illnesses of early childhood have other causes. Secondly, the reports suggest that the recommended contraindications to pertussis immunisation are genuine and important because children immunised in spite of contraindications are more likely to suffer neurological complications. Thirdly, the experience of the whooping-cough epidemic in the UK in 1977-79, after the dramatic fall in immunisation rates, leaves no doubt that pertussis immunisation does protect the child against the disease. The reports have already been commented upon.2-4 Here we discuss the aspects which are of most concern to paediatricians.