Immunization against whooping cough in Salford: a spatial analysis.

The decline in pertussis (whooping cough) immunization in the 1970s is related to public concern about the safety of the vaccine. The debates about its safety and effectiveness and the impact of vaccination on notifications are reviewed. A study is made of spatial variations in vaccine uptake within the metropolitan district of Salford, Greater Manchester, using data available at ward level. Salford as a whole has one of the lowest rates of uptake in the North Western Regional Authority, which itself has the lowest uptake in the country. Variations from ward to ward are noted and an attempt is made to account for these using Poisson regression. Both the number of children being immunized against pertussis and the number receiving diphtheria and tetanus vaccine (but foregoing the pertussis component) are used as dependent variables. Of the explanatory variables social class proves a useful predictor. However, the analysis is an ecological one and further work is called for at the scale of individual clinics in order to investigate health worker and parental attitudes and the accessibility constraints felt by those responsible for bringing children to clinics.