Selective primary health care: strategies for control of disease in the developing world. XVII. Pertussis and diphtheria.

Pertussis and diphtheria, bacterial infections responsible for significant childhood morbidity and mortality in the developing world, are potentially controllable by mass immunization. The incidence of pertussis has been dramatically reduced in many areas of the world over the past 25 years by the use of pertussis vaccine. The massive increase in incidence of clinical pertussis in Great Britain and other European nations occurring after publicity about vaccine reactogenicity precipitated a marked decrease in vaccine acceptance has documented the efficacy of the vaccine and the necessity of continued immunization. The issue of potential toxicity is, nevertheless, being addressed with the development of a cell-free, component pertussis vaccine. The use of diphtheria toxoid, directed at protecting recipients against the systemic effects of diphtheria toxin, has resulted in excellent control of the disease in the United States and elsewhere. Certainly the use of these two vaccines on a mass scale is the preferred approach to worldwide control, if not eradication, of these infectious diseases.