We present a case finding study of serologically confirmed Pertussis amongst BFG-based returnees from Op HERRICK. The role of Pertussis in the aetiology of the commonplace “Kabul Cough” is discussed. It is recommended that enhanced health surveillance for Pertussis takes place both during and after future deployments to Afghanistan, to prevent the potential onward transmission of a potentially fatal illness to unimmunised children. ORIGNAL PAPER PERTUSSIS - A CASE FINDING STUDY AMONGST RETURNEES FROM OP HERRICK N K Cooper 1† , MCM Bricknell 2 , GR Holden 1 , C McWilliam 1 1 HQ BFG Health Service, BFPO 40; 2 CH MED HQ ARRC, BFPO 40; † now QEMHC, St Michael’s Road, Tidworth, Wiltshire SP9 7EA Abstract Introduction Anecdotal descriptions of a chronic, usually non-productive, cough - so called "Kabul Cough"- have accompanied all multinational deployments to Afghanistan since 2001. This has thought to have been caused by environmental pollution, but air sampling by most of the national contingents involved has been equivocal in its results as compared with the high levels of pollution recorded by air sampling in the cities of other developing countries. Accordingly other factors, including respiratory tract infections, have been considered as aetiological factors in its genesis. T he potential role of Pertussis in the causation of respiratory symptoms amongst British personnel deployed on Op HERRICK (Afghanistan) has been highlighted by a small outbreak amongst immunised children in British Forces Germany (BFG) in April 2006, who were in contact with family members newly returned from serving in Afghanistan (1). Furthermore, a severe case of confirmed Pertussis arose in the Operational T heatre in December 2006. To investigate the prevalence of Pertussis infection in a group of easily identified “symptomatic” soldiers returning from OP HERRICK, Chief Med ARRC commissioned BFG Health Service (HS) to organise a case finding exercise at a suitably located medical centre. T he need for this study was further underlined by 2 symptomatic UK ARRC Officers being serologically diagnosed as Pertussis positive by the laboratory of a French Military Role 2 Hospital in Kabul in early 2007. Methods Returnees to HQ ARRC (situated at BFG Rheindahlen) meeting a case definition of: 14 days or more of cough plus paroxysms, whoop, or post cough vomiting, as defined by UK guidelines (2) were encouraged to attend a dedicated clinic at the beginning of February 2007, approximately 14 days after returning from Kabul. Serology and oral fluid samples were taken with informed consent, which specifically advised about the health implications of a positive result and the likely need for antibiotic therapy to protect them and their contacts. O ral fluid samples were taken by rubbing a sterile swab along the gums for one minute until fully wet. Each sample was placed in an appropriate container supplied by the Respiratory and Systemic Infection Laboratory (RSIL) at the Health Protection Agency in Colindale, UK. T he samples were sent via express courier to the RSIL where they were examined for anti-Pertussis toxin IgG antibody levels. In the absence of recent vaccination, RSIL deemed >100 serological enzyme Units or >70 oral fluid enzyme Units/ ml as being consistent with a recent infection with Pertussis. Results Table 1 details the 21 patients (19 male) sampled in the clinic, specifically excluding the two serologically positive cases already confirmed from T heatre. T he age range was 28-49 years and the rank range was Corporal to Brigadier. From the tested cohort of 21 symptomatic individuals there were 2 confirmed and 1 probable cases of Pertussis infection. Discussion Whooping cough, also known as the cough of 100 nights, is a highly infectious and severe respiratory disease, spread by coughing and sneezing. T he full blown disease takes one to three weeks to develop and the initial symptoms of runny nose, fever and dry cough can be difficult to distinguish from other common respiratory infections. Coughing gradually increases in frequency and duration, and within a few weeks, develops into prolonged and exhausting coughing bouts. Young children, especially babies in the first year of life, can become seriously ill due to uncontrollable coughing, many require hospital admission. Following the introduction of Pertussis vaccine into the universal childhood immunisation schedule in the 1950’s the incidence of whooping cough in children in the UK declined rapidly. Following a scare regarding vaccine safety in 1974 there was a brief resurgence of the disease due to poor vaccine uptake, however over the last 30 years vaccine uptake has been high and incidence of the disease low. Recent information from the UK, NW Europe and North America (3- Correspondence to: Captain C McWilliam ARRC RN(A) QARANC, SO3 Health, HQ BFG Health Service BFPO 40 address Email: catherine.mcwilliam259@land.mod.uk 114 JR Army Med Corps 153(2): 114-116 114-116 Pertussis 26/7/07 13:56 Page 114