Whooping cough epidemic despite immunisation

Press, 2 May 1988, Page 4

Whooping cough epidemic despite immunisation

From

Dr lan St George

for the Royal New Zealand College of General Practitioners

An epidemic of whooping cough occurred in Dunedin in the spring of 1986. Dr Murray Tilyard, of a Dunedin research unit, his partner, Dr Tim CareySmith, and a laboratory technologist, John Finlayson, report on 22 cases from one suburban medical centre in the autumn issue of the “New Zealand Family Physician.” Eighteen of these were children, all were aged over one year, and most were over five; none were sick enough to need admission to hospital. All those under 15 had been immunised against whooping cough in infancy. So, in spite of immunisation, whooping cough is still common in children. The immunity gained by the injections at six weeks seems to protect those under a year old fully, and those up to five years old almost fully. After five years the protection is less complete, but immunisation is still the likeliest reason that whooping cough is a far less severe illness than it was. Bodyache Dr Simon Carson is a Christchurch family doctor who is. working as an associate professor in the department of family and community health in the Sultanate of Oman. He writes in the autumn issue of the “Family Physician”

about a condition he sees very often there. His Omani patients call it bodyache.

A broken leg is a broken leg, and the way the patient presents and the way the doctor assesses and treats it are the same in New Zealand and in Oman. Not so for the problems a family doctor sees. There are great variations in the way illness is presented, and in the cultural expectations of medical care. Among all the specialties family medicine is the most closely linked to the culture of the country in which it is practised. Bodyache is an example. The New Zealander does not complain of bodyache. But Dr Carson has begun to identify a group of patients in Oman for whom bodyache is the main complaint. Pain all over the body, for some time, and no treatment had worked. No abnormal physical findings, and no abnormal laboratory tests. There exists a group of New Zealand patients who complain of tiredness, lack of energy, poor sleep, headaches, and muscular pains, for whom we can find no abnormal physical signs and no abnormal laboratory tests. We may call it “M.E.” or “Tapanui flu” rather than bodyache, but perhaps it is the same thing.