readily established in most children by primary immunisation alone, and the prime benefit of reinforcement at school entry may be to prolong immunity through adolescence into adulthood. In the case of poliomyelitis, reinforcing immunisation was largely without effect, probably on account of exclusion by pre-existing antibody. Thus it might be argued that, except in the case of immunity to diphtheria, the benefits of reinforcing immunisation are chiefly the immunisation against tetanus and poliomyelitis of children who have inadvertently missed primary immunisation.Extrapolation from the samples to the cohorts from which they were drawn provides estimates of the percentages of children who, by the criteria of this study, may be considered to have been adequately protected. Thus in the 1969 cohort, in which the best immunisation coverage was achieved (84% of the children were fully immunised and a further 14% had received primary immunisation, although not reinforcement), the estimate of those protected from tetanus was 980% and of those protected from diphtheria and all three types of poliomyelitis 85%0. In view of the excellence of the protection from tetanus and the additional protection provided by the herd in the cases of the communicable infections, it seems unreasonable to suppose that more rigorous implementation of an immunisation programme would provide anything other than marginal additional benefit.We thank the children for the blood samples, and their parents for allowing them to participate; Mr L Youens and Mrs Vivienne Miller and staff of the child health service of the Avon AHA; the doctors of the Avon AHA for perform-iing the venepunctures; Dr Suzanne Clarke, of the Bristol PHLS Laboratory, for separating the sera; and Miss

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SUMMARY In an attempt to determine the clinical severity and prognosis of children admitted to hospital with whooping cough, 127 patients were studied prospectively during a 12-month period. Clinical and laboratory criteria were used and the impression gained was that most cases were mild, although 3 children were dangerously ill and at least 30% had symptoms lasting 2 months or longer.There were no deaths, and no permanent sequelae were noted. The mean age of patients was higher than in other series, which might have accounted for the fairly low severity. Although there was some evidence of a decline in severity and mortality, whooping cough is still an unpleasant and protracted illness.

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