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In Reply: The issue of pertussis raised by Dr Jimbo is reasonable. Although not all cases of pertussis will present in the typical fashion,¹ patients in whom the clinician made the clinical diagnosis of pertussis were excluded from the study. As with all other exclusions (such as asthma, pulmonary embolus, chronic obstructive lung disease, and left ventricular failure), the exclusion of pertussis was made at the physician's discretion based on the clinical diagnosis; for each exclusion, we did not provide standardized criteria or specify routine laboratory testing since this does not occur in everyday practice. Thus, it is possible that some cases of pertussis may have been included in this pragmatically defined clinical cohort.

However, UK surveillance data² suggest low incidence rates of pertussis in the late 1990s. In 2001, a pertussis booster was introduced to the routine UK schedule, and incidence has probably decreased further.³ Moreover, the natural history . . . [Full Text of this Article]

Paul Little, MD
p.little@soton.ac.uk
Primary Medical Care Group
University of Southhampton
Southhampton, England

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