Worst of coughing epidemic to come

By MARTIN JOHNSTON health reporter

Doctors predict the whooping cough epidemic afflicting New Zealand is likely to rage on for many months yet, despite a drop in the monthly total of cases notified.

They warn that children's best protection is to receive the full course of four immunisation injections.

In the 12 months to the end of April, there were 2039 cases of the bacterial infection nationwide, compared with 158 for the whole of 1998. An eight-week-old Waikato baby who died of the disease in February is believed to be the only death so far in this epidemic.

Reports of the potentially fatal meningococcal disease are rising, with 126 cases and two deaths up to May 19, compared with 115 cases and two deaths in the same period last year. The nine-year epidemic has claimed 150 lives.

Whooping cough, which can last up to 10 weeks, usually causes an uncontrollable cough that can induce vomiting. It affects babies worst and can cause them to stop breathing, suffer brain damage, and even to die.

It is highly infectious from coughed-out droplets and the Immunisation Awareness Centre medical director, Dr Nikki Turner, urged caution in taking babies into places where there were many children, particularly sick ones.

The epidemic hit Southland first, from last May, quickly spread to Canterbury and Nelson-Marlborough, then from September started affecting Auckland, Waikato and some other North Island districts.

The monthly national tally peaked in February at about 320 cases and declined to 224 in April.

An Auckland Healthcare public health specialist, Dr Chris Bullen, said the reduction was probably only temporary.

"We're certainly expecting a lot more cases here in Auckland unfortunately," he said, noting that the North Shore had been the region's worst affected area so far.

"The message is: if your child hasn't been immunised or hasn't had a full course then now is the time before we see the full force of this."

The free childhood vaccine is generally given along with those against diphtheria, tetanus and haemophilus influenzae B (which is not the viral flu).

Vaccine advocates say the risks of severe adverse reactions from the vaccine are far less than those of major complications from whooping cough.

Dr Turner said the whooping cough vaccine was fully effective in 85 per cent of patients after a full course and for the rest it reduced their symptoms if they caught the bug.

Whooping cough epidemics start here every three to five years, each lasting 18 months to two years.

With the peak meningococcal-disease season about to start, health authorities are again preparing an awareness campaign that includes door-knocking in high-risk suburbs.

The lightning-fast disease is transmitted by close contact, often through sharing saliva.

Doctors say the commonest signs are fever, vomiting, or a rash of purple or red spots anywhere on the body. Suspected victims should be taken to a doctor.

"We hope to encourage parents to take their children to the doctor as soon as they find them suffering from one or more of these signs," says Dr Philip Hill, who heads the Auckland awareness programme.

Among infants under one in some poor Auckland suburbs, nearly 1 in 100 Pacific Islanders and 1 in 250 Maori catch the disase, compared with 1 in 2000 Europeans region-wide.