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Pertussis, also called whooping cough: Understanding and considerations

General, Infant and Children | April 21, 2015 | Author: The Super Pharmacist

Children, infant

Pertussis, also called whooping cough: Understanding and considerations

Pertussis, more commonly known as whooping cough, is a highly contagious bacterial infection of the lungs and airways caused by the bacteria Bordetella pertussis. It is known as whooping cough due to the distinctive noise that those who have the disease make when trying to take a breath after bouts of intense coughing. In its most severe form the disease can last for several months.This is why it is also sometimes referred to as the ‘hundred day cough’.

Transmission and risk

Bordetella pertussis is transferred through airborne droplets when someone with the infection coughs or sneezes. It is infectious from the first sneezes throughout the course of the disease which can last for up to 8 weeks. The highest risk group for pertussis are newborns and infants under the age of six months.

Pertussis is predominantly a childhood illness, although it can also occur in adult populations. Close contacts of infected individuals who are not vaccinated, partially vaccinated or particularly vulnerable to infectious disease should be given prophylaxis to protect them against whooping cough. 

How does whooping cough develop?

After someone is infected with the bacteria, symptoms will typically appear somewhere between 7-14 days later. However, this period can last up to 21 days. Initially the symptoms tend to be mild and are then followed by a period of more severe symptoms. Early symptoms often mirror those of a common cold and may include sneezing, an irritating dry cough, watery eyes, a raised temperature, and a blocked or runny nose. These symptoms can last for up to a week. The more severe symptoms are characterised by very intense coughing. Symptoms include:

  • Bringing up thick phlegm as a result of prolonged intense coughing
  • A ‘whoop’ sound with each intake of breath after intense coughing
  • Tiredness and redness in the face from excessive cough
  • Vomiting induced by coughing (particularly in infants and young children)

The cough itself is very persistent, and each bout usually lasts for between 1-2 minutes at a time. The number of coughing bouts will vary by individual, although on average it is estimated that there will be between 12-15 bouts of intense coughing every 24 hours. Even when the disease has been diagnosed and treated, the cough can last in excess of a month. Infants younger than six months may not display the characteristic ‘whoop’ sound after coughing, and may alternatively gag or gasp for air. In some instances, they may also temporarily stop breathing.

Treating whooping cough 

The bacterium responsible for whooping cough can be treated with a course of antibiotics, although once the bouts of coughing have started they make little impact on the actual course of the illness. They are prescribed primarily to control further outbreak of the disease because after a five day course individuals are no longer contagious. Without antibiotics, people who have whooping cough will remain infectious for a much longer period of around three weeks after bouts of coughing first start.

Occasionally, whooping cough can be so severe that individuals with the disease are hospitalised. Inpatient treatment usually consists of making sure fluid intake is adequate, oxygen therapy and mechanical ventilation in the most severe cases. Hospital admissions for whooping cough are predominantly for children less than 6 months old with underlying conditions that complicate the illness such as cardiac, respiratory or neuromuscular disease.

The pertussis vaccination

The pertussis vaccination was introduced globally in the early 1950s and is largely responsible for the low rates of whooping cough where it is available. The vaccine is given as part of the routine childhood immunisation schedules in many countries and is typically administered to children at 2 months, 3 months and 4 months of age. It is given as part of the 5-in-1 vaccine which also protects against diphtheria, tetanus, polio and Hib (haemophilus influenzae type b). An additional dose is also given just before children start school (between 3 and 5 years of age) for an additional boost of protection against whooping cough.

Where regions or countries are regularly affected by outbreaks of pertussis, pregnant women are offered vaccination against whooping cough between weeks 28-38 of pregnancy, with the immunity from the vaccine passed from mother to baby through the placenta to provide protection. This has proven to be very effective, with babies born to women who received the vaccination at least a week before birth having a substantially reduced risk of becoming ill with whooping cough.

As well as pregnant mothers, any individual providing care to people at heightened risk of contracting whooping cough such as nannies and carers should also have the vaccine. There are few reasons why individuals are unable to receive the pertussis vaccine. Individuals who want to have the vaccine should talk to their family doctor if they have, at any stage, experienced an anaphylactic reaction to the pertussis vaccine or neomycin, streptomycin and polymxin B (trace amounts are contained in the 5 in 1 injection).

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References

NHS: Whooping Cough (Introduction) http://www.nhs.uk/conditions/whooping-cough/pages/introduction.aspx (last accessed 12th April 2015)

NetDoctor: Whooping Cough. http://www.netdoctor.co.uk/diseases/facts/whoopingcough.htm (last accessed 12th April 2015)

WebMD: Pertussis. http://www.webmd.com/children/tc/whooping-cough-pertussis-topic-overview (last accessed 12th April 2015)

Health Protection Agency: Pertussis. http://www.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListName/Page/1191942148389?p=1191942148389 (last accessed 12th April 2015)

NHS: Pertussis (Symptoms). http://www.nhs.uk/Conditions/Whooping-cough/Pages/Symptoms.aspx (last accessed 12th April 2015)

Greenberg DP, von Konig CH, Heininger U. (2005).Health burden of pertussis in infants and children Pediatr Infect Dis 24(5 Suppl):S39-43

NHS: Whooping Cough (Prevention). http://www.nhs.uk/Conditions/Whooping-cough/Pages/Prevention.aspx (last accessed 10th February 2015)

Campbell H, Amirthalingam G, Andrews N, et al. Accelerating control of pertussis in England and Wales. Emerg Infect Dis 2012 Jan;18(1):38-47

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