Examining the whole-cell pertussis vaccine scare and its repercussions

In 1974, a paper published in Archives described a series of children who suffered serious acute and, usually long-term, neurological events after inoculation with the combined diphtheria/tetanus/pertussis vaccine. Despite this being a case series, with no controls, the authors posited a causal connection and blamed the whole-cell pertussis component. This message was taken up by the UK media and raised in Parliament. Almost overnight the uptake of the combined vaccine fell and notifications of pertussis rose. It took 15 years for uptake of the vaccine to recover. Twenty-four years following publication of the Archives paper, a smaller case series was published in the Lancet , claiming a link between bowel problems and autism. A temporal association with the MMR vaccine was noted and the lead author called for a ban on the combined vaccine. This resulted in a fall in MMR vaccine uptake. There is now a significant body of evidence in favour of no causal link but many parents remain hesitant about vaccinating their children. Authors, editors and publishers should be aware of the effect that an article published in a high-quality academic publication can have on public health. Although it is not appropriate to suppress good research, whatever the message, it is an ethical imperative to ensure it is truly evidence-based.