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ToggleSummary about whooping cough
Whooping cough, also called pertussis (name of the bacteria that causes this infection), is a potentially very serious illness if it occurs in infants and young children who are not immunized against the disease, especially newborns younger than 2 months who have not yet received the first dose of the vaccine (vaccination schedule below). In addition, newborns have very thin airways, which can be easily obstructed by the mucus produced in the infection. In some cases, they may not even be able to breathe.
Whooping cough is a highly contagious disease and can last for several weeks. read symptoms
In most countries considered developed (Europe, North America, Japan, etc.) vaccine coverage is very high and there are few cases of whooping cough and especially death from the disease. On the other hand, in developing countries, this disease continues to cause damage and even in emerging countries like Brazil, several deaths have been recorded in recent years as a result of very low vaccination coverage of adults (adults can then transmit the disease to infants or young children).
In Texas (USA), a highly industrialized and rich region compared to other regions of the world, was hit by a pertussis epidemic in September 2013, at least two deaths were recorded. Low immunization of adults (only 12% of adults were immunized against pertussis) is one of the causes for this Texas epidemic, because most newborns and young children were infected by adults.
As discussed in this session, immunization is essential and central to the strategy to reduce child mortality, especially in developing countries. Let’s not forget that pertussis causes more than 500,000 deaths a year in children.
Definition
Whooping cough is an infectious disease caused mainly by the bacterium Bordetella pertussis, the latter produces a toxin causing the symptoms of whooping cough, constipation, etc.
Be aware that whooping cough is an illness that can last for several weeks and be very tiring. In fact, the patient may have violent and uninterrupted coughing spells, and in newborns respiratory problems such as apnea may appear and worsen.
Newborns have very thin airways and they can be easily obstructed by mucus.
Epidemiology
History of the disease and mortality rate
– Vaccination of children as young as 2 months since the 1940s has considerably reduced the incidence of the disease and infant mortality. Until the early 1950s, there were millions of cases of pertussis each year, with many infant deaths worldwide.
The WHO estimates that each year 600,000 children die from pertussis and about 60 million children are afflicted. About 90% of patients affected by pertussis are children.
In Brazil, pertussis cases were already quite high, reaching an incidence rate of 30 cases per 100,000 inhabitants in the early 1980s. However, due to vaccination and disease prevention campaigns, pertussis cases remained lower to 0.05/1000 inhabitants in recent years.
The group of children under 1 year of age accounts for around 50% of pertussis cases. The lethality of the disease is also high in young children, and practically all deaths from this disease are concentrated in babies or younger children [Source: Ministry of Health].
– According to a study carried out by the Boston University School of Public Health , the increase in the number of pertussis cases in the 2010s, mainly in the United States, comes from the use of so-called acellular vaccines (in English: acellular vaccines ) used since the 1990s. These would not be as effective as whole-cell vaccines., which have been used since the beginning of pertussis vaccination. The use of acellular vaccines emerged as whole cell vaccines raised concerns about potential neurological adverse effects. To arrive at these conclusions, American scientists mainly used mathematical models of the immune response to these 2 types of vaccines in experiments carried out with animals. This study was published online August 25, 2017 in the scientific journal F1000 Research (DOI: 10.12688/f1000research.11654.1).
Causes & Transmission
As we have already seen in the definition, whooping cough is mainly caused by a toxin produced by the bacterium Bordetella pertussis (also called the Bordet-Gengou bacillus).
In some cases (5-20%) pertussis can be caused by Bordetella parapertussis. This type of whooping cough is less serious than that caused by Bodetella pertussis.
Streaming
Person-to-person transmission (for example, adult to adult, or adult to infant or young child) is through droplets from the respiratory tract during coughing .
Groups of risk
People at risk are especially babies and young children. It is estimated that parents of children younger than 6 months are particularly concerned about reports of severe pertussis (especially with complications such as pneumonia and risk of death).
Newborns younger than 2 months have not yet been immunized against pertussis (the first dose of the vaccine is administered at 2 months) and can therefore more easily develop this infectious disease. At this age, the risk of pertussis complications is high, because your airways are very thin and can be obstructed by mucus.
Symptoms
Pertussis incubation period:
Once the body (usually the respiratory part) is in contact with pertussis bacteria, it takes about 7 days to see the first symptoms.
Important notes about the symptoms:
– It must first be noted that the symptoms can vary greatly from one individual to another, generally in adults the symptoms are milder because the body is stronger, the consequences are almost always benign and not very dangerous. On the other hand, in small children, and especially in children younger than 6 months, the consequences of pertussis can be very serious and can even lead to death. To summarize, the most severe cases of pertussis can occur in younger people and therefore the illness can be serious.
– Be aware that pertussis vaccination is mandatory, but often children have not yet received all doses of the vaccine and are not immunized against pertussis (especially from birth to the age of a few months). The risk is greater if the child is in contact with an adult who has pertussis. As a consequence, only a total immunization of society will reduce the number of pertussis in infants.
Or in other words, an adult properly immunized (all doses of vaccines made with remember) will not develop the disease and thus avoid transmission to a young child who has not yet received all doses of vaccines. Lives can be saved by being up to date on vaccinations.
Symptoms
Moderate phase:
– After the incubation period, there is usually a mild cough , mild fever and nasal congestion. These symptoms are close to a cold . The eyes may also be red or watery.
More severe phase:
– A few days after these mild symptoms, a much more aggressive and continuous cough can be observed (night and day) with true coughing fits. Sometimes, we speak of “rooster crow” to describe this specific cough. These attacks may be followed by a pause in breathing, leading to cyanosis. This cough can even cause bleeding in the eyes and brain in some cases.
– In babies, whooping cough can cause apnea (respiratory arrest) without the presence of cough. A red or blue face may manifest. Another complication of coughing in babies is progression to pneumonia (a serious infection of the lungs). This non-stop coughing can last from 2 to 4 weeks. Subsequently, and therefore after this period of violent coughing in fits, a milder or isolated cough may still appear for a few weeks. Extreme fatigue may also appear.
Origin of the symptoms:
It is interesting to note that the multiplication of bacteria causes whooping cough because it reduces the functioning of the trachea and bronchi. The cough is a consequence or a symptom of the problem.
Diagnosis
The diagnosis of whooping cough can be made by observing the clinical signs: coughing for several days and weeks, in particular with coughing fits, etc.
To be sure it’s whooping cough, your doctor may do a lab test to identify the bacteria that cause the disease.
Treatments
Curative treatment of whooping cough
The main treatment involves taking antibiotics . Antibiotics are effective against bacterial infections such as whooping cough. Antibiotics are chosen according to our needs, especially macrolides, and the doctor is obviously the only person who can prescribe this type of medication.
An important purpose of taking antibiotics is to reduce the spread of disease. In young children and infants, whooping cough can potentially be very serious, and therefore it is advisable to treat the condition in hospitals to better monitor the young patient’s condition. This will isolate the patient as much as possible to prevent contamination.
The health team will report any cases of pertussis in the country to the health authorities.
Cough treatment
According to the Mayo Clinic, an American reference institution, treatments to cure cough are ineffective and should be avoided. Instead, priority should be given to certain measures such as drinking plenty of fluids, resting and eating smaller portions (for more information, see Tips below).
Preventive treatment (pertussis vaccination)
The best way to fight this disease is vaccination of all people and especially young children. In general, we recommend vaccination against pertussis (also called pertussis) from the age of 2 months for every three injections one month apart. In its first year of life, the child will have received 3 doses of vaccine.
One year after the last vaccination, the child will receive a booster (for about 2 years), and then a second booster during adolescence at ages 11-13 years (in Switzerland, 4-7 years are advised). It is important to note that this standard can vary slightly depending on each country and type of vaccine, so talk to your doctor or pharmacist about the exact standard of vaccination in your region or country.
It is estimated that a booster in adulthood is recommended especially for people in contact with young children (medical staff or parents, in this case the mother must be vaccinated before pregnancy or soon after) and, especially babies, to prevent at all cases the transmission of pertussis. Some sources estimate that the effectiveness of vaccination is, in general, excellent, however its effect tends to disappear in adulthood, and therefore reinforcements are always welcome. Talk to your doctor.
Also note that the pertussis vaccine is often combined with a vaccine against two other infectious diseases: diphtheria and tetanus. This is known as the DTP or triple vaccine (diphtheria, tetanus and pertussis or pertussis).
Pertussis vaccination in adults :
Swiss health authorities have recommended, since February 2012, an additional booster vaccine against pertussis in young adults between 25 and 29 years old and to all future parents (pertussis is not dangerous for an adult, but it is extremely serious for a child who has not yet been vaccinated, and who is possibly your future child), and also for all adults in regular contact with children.
In France, Germany and the United States, future parents are already informed that a booster against whooping cough can be proposed by the doctor, and especially in cases concerning immunization for children (as in cases where children have not received all five doses).
In the United States, the reference institution Mayo Clinicencourages all adults to be vaccinated against pertussis at least once, according to an article published in January 2020 (link working on 15.01.2020).
Tips & Prevention
– Everyone, children and adults, should be up to date with pertussis vaccines. On the one hand, vaccination is essential to avoid contracting the disease, but it is also important to protect society and especially young children who are at risk of acquiring the disease.
If an adult has never been vaccinated against whooping cough or is not up to date, they should be vaccinated to prevent spreading the disease to an infant or young child. Because if the adult is sick, it can easily pass on to a small child or baby.
– It is interesting to note that the bacterium that causes pertussis is more active at elevated temperatures.
– Drink plenty of fluids, such as: juices, soups, teas or simply water. This advice is especially recommended for children to avoid dehydration (which can be manifested by dry mouth, peeing little or crying without tears).
– Rest. A person with whooping cough should rest as much as possible, as with most infectious diseases, rest helps to strengthen the immune system.
– Eat small portions, preferably several small meals rather than large amounts. This tip is useful to avoid vomiting after coughing.
– Keep the air clean. Avoid toxins like cigarette smoke in the home. These irritants can encourage coughing .
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