Editor—Tyrer in his editorial on the national service framework for mental health and its wish lists is perpetuating several myths about NHS Direct that seem to be held by doctors who feel threatened by the new service.1
Firstly, NHS Direct is not a counselling service, and the qualified nurses who answer the telephones are not counsellors.
Secondly, general practitioners should have no problem with NHS Direct “splitting care” since NHS Direct does not provide care. It is an advice giving and signposting service. It does not seek to undermine the relationships between general practitioner and patient—exactly the reverse.
A substantial proportion of those who telephone NHS Direct will have a mental health problem, and a need for training has been identified. At the Depression Care Training Centre, we have been working with another organisation, Healthcare Productions Limited, to develop suitable training materials for NHS Direct nurses to enable them to advise this group appropriately. Neither organisation is in the NHS, and the funding comes from a pharmaceutical company (SmithKline Beecham). Fine words about primary care training are not quite enough.
Editor—In a letter to all doctors last December the chief medical and nursing officers and pharmacist announced that triple vaccines against diphtheria, tetanus, and pertussis containing acellular pertussis would, for the first time, but only temporarily, enter routine use for infants in the United Kingdom.1 Difficulties in obtaining supplies of triple vaccine containing whole cell pertussis during 1999 seem to have precipitated this decision.
We found a much lower rate of febrile reactions in infants in the United Kingdom given triple vaccine combined with vaccine against Haemophilus influenzae type b when the pertussis vaccine was acellular rather than whole cell; both groups were given injections at 2, 3, and 4 months.2 In November last year new data from Canada showed a noticeable reduction in more serious reactions to pertussis vaccine in infants after switching from whole cell to acellular vaccine.3 New combined formulations including vaccine against meningococcus group C and hepatitis B, pneumococcal conjugate vaccine, and inactivated poliovirus will certainly be based on or tested alongside triple vaccine containing acellular pertussis. As in its use of oral polio vaccine,4 the United Kingdom is becoming increasingly isolated among its European neighbours in its routine use of whole cell pertussis vaccine. Health professionals and the public may also become confused and uncertain about the comparative merits of the whole cell and acellular preparations currently being used alongside one another.
We believe that the time has come in the United Kingdom to use acellular pertussis vaccines as the basis of the complex infant immunisation schedule of the future.
Footnotes
The training centre is endorsed by the RCGP Unit for Mental Health Education in Primary Care.
Competing interests: The company of which Ms Armstrong is executive director is a company limited by guarantee and receives payments and fees for services from a variety of organisations.
Competing interests: This group has received research funding from vaccine manufacturers including Pasteur-Merieux and SmithKline Beecham, which manufacture the acellular triple vaccines currently in use. Dr Finn has received reimbursement for attending symposiums, fees for speaking, and funds for research. He has done consultancy work for SmithKline Beecham.
References
- 1.Donaldson L, Mullally S, Howe J. London: Department of Health; 1999. Current vaccine issues—action update.www.doh.gov.uk/cmo/cmoh.htm . (PL/CMO/99/5, PL/CNO/99/9, PL/CPHO/99/4.) ( www.doh.gov.uk/cmo/cmoh.htm) ) [Google Scholar]
- 2.Bell F, Heath P, MacLennan J, Shackley F, Shearstone N, Diggle L, et al. Adverse effects and sero-responses to an acellular pertussis/diphtheria/tetanus vaccine when combined with Hib vaccine in an accelerated schedule. Eur J Pediatr. 1999;158:329–336. doi: 10.1007/s004310051083. [DOI] [PubMed] [Google Scholar]
- 3.Scheifele DW, Halperin SA, Pless R, Delage G, Jadavji T, Vaudry W, et al. Marked reduction in febrile seizures and hypotonic-hyporesponsive episodes (HHE) with acellular pertussis-based vaccines: results of Canada-wide surveillance, 1993-8 (abstract) Clin Infect Dis. 1999;29:966. [Google Scholar]
- 4.Finn A, Bell F. Polio vaccine—is it time for a change? Arch Dis Child. 1998;78:571–573. doi: 10.1136/adc.78.6.571. [DOI] [PMC free article] [PubMed] [Google Scholar]