East africa university

 Semester six

 Communicable disease
 Lecture four

 By buruj
Whooping couph
Contents of pertusis
 Introduction
 Brief history
 Definition
 Epidemiology of determinant
 Mode transmission
 Incubation
 Clinical features and symptoms
 Complications
 Risk group
 Diagnosis
 Treatment
 Prevention and control
Pertusis (whooping couph
 Whooping cough, or pertussis, mainly affects
infants and young children.
 Caused by a bacterium, it is characterized by

paroxysms (intense fits or spells) of coughing

that end with the characteristic “whoop” as air
is inhaled.
Problem statement
 Pertusis is an important cause of death in
infants and world wide, continues to be a
public health concern even in countries with
high vaccination coverage. Estimates from
WHO suggest that in 2008 about 16 million
cases of pertusis occurring world wide , 95
per cent of which were in developing
countries and about 195000 children died
from from this disease.
 Before vaccines became widely available,
pertusis was one of the most common
childhood disease world wide following large
–scale vaccination during the 1950s and 1960s
a dramatic reduction (˃90 percent) in incidence
and mortality of pertusis was observed in the
industrialized world.
 Pertusis vaccine (DPT) has been part of WHO,s
EPI since its inception in 1974, in 2008 about
80 percent of all infants world wide received 3
doses of pertusis vaccine.
History
 The first definite account of the disease was
recorded by the French physician in 1578,
 The first clear and thorough description of it
came from Thomas Willis an English
physician, in 1675.
 Another English physician, Thomas
Sydenham, introduced the term whooping
cough that same year.
 1906 - While carrying out research on
antibody and antigen reactions in blood,
Bordet and Gengou discovered the bacillus
that causes whooping cough. The two
scientists were then able to prepare a vaccine
for the disease.
 Unfortunately, the Bordet-Gengou vaccine

was not very effective and whooping cough

continued to be a dreaded disease
 In 1932 Dr. Pearl Kendrick and Dr. Grace
Eldering
◦ Gathered specimens from children in poor,
Depression-era homes
◦ Developed precise, standard methods of preparing
vaccine
◦ Established sterility, safety, and effectiveness tests
◦ Conducted well-controlled field trials.
definition
 An acute infections disease usually of young
children caused by B.pertussis. It is clinically
characterized by an insidious onset with mild
fever and an irritating cough gradually
becoming paroxysmal with the characteristic
“whoop”(loud crowing inspiration) often with
with cyanosis and vomiting. The spectrum of
disease varies from severe illness to atypical
and mild illness without whoop the Chinese
call it a “hundred day cough”
Epidemiological determinants
 Agent factors
 Agent : the causative agent in a large

proportion of cases is Bordetella pertussis. In

a small of cases (less than 5 per cent).
 B) source of infection: B.pertusis infects only
man. The source of infection is a case of
pertusis.More often , may be mild , missed
and unrecognized.
 C) infective material:
 The bacilli occurs abundantly in the

nasopharyngeal and bronchial secretions,

which are infective. Objects freshly
contaminated by such discharges are also
infective
 D) infective period: whooping cough is most
infectious during catarrhal stage.
Host agent factor
 A) age: whooping cough is primarily a disease
of infants and pr-school children. The
highest incidence is found below the age of 5
years.
 B) sex: incidence and fatality are observed to

be more among female than male children

 C) immunity: recovering from whooping

cough or adequate immunization is followed

by immunity.
Environmental factor
 Pertusis occurs through out the year, but the
disease shows a second trend with more
cases occurring during winter and spring
months, due to overcrowding . Socio-
economic conditions and ways of life also
play a role in the epidemiology of the disease.
Thus, the risk of exposure is greater in the
lower social classes living in overcrowded
conditions than in well –to –do groups.
Mode of transmission
 Whooping cough is spread mainly by droplet
infection and direct contact. Each time the
patient coughs, sneezes or talks, the bacilli
are sprayed into the air. Most children
contract infection from their playmates who
are in the early stages of the disease. The role
of fomites in the spread of infection appears
to be very small, unless they are freshly
contaminated
 Incubations period
 Usually 7 to 14 days , but not more than 3

weeks
What are the symptoms
 The disease usually takes one to three weeks
to incubate, with the child usually passing
through three stages.
 The following are the most common

symptoms of whooping cough, according to

each stage.
 Catarrhal stage (often lasts one to two
weeks):
◦ mild cough
◦ low grade fever
◦ runny nose
 Acute phase or paroxysmal (may last for
several weeks):
◦ Cough gets worse and comes in severe fits
◦ Cough is dry and harsh
◦ Cough ends with a whoop sound on inspiration
◦ Child may vomit with the coughing and appear to
be strangling on the vomit
◦ Cough can be started by many factors, including
feeding, crying, or playing
 Recovery phase or convalescent (usually
begins around the fourth week):
o Vomiting and the whooping cough cease first
o The cough usually decreases around the sixth
week, but may continue on occasion for the next
one to 2 months
◦ Whooping cough can last up to several weeks and
can lead to pneumonia
complications
 Major complications are most common
among infants and young children and
include:
◦ Hypoxia
◦ Apnea
◦ Pneumonia
◦ Seizures
◦ Encephalopathy
◦ Malnutrition.
 Most deaths occur among unvaccinated
children or children too young to be
vaccinated
Risk groups
 Children who are too young to be fully
vaccinated and those who have not
completed the primary vaccination series are
at highest risk for severe illness.
 Like measles, pertussis is highly contagious
with up to 90% of susceptible household
contacts developing clinical disease following
exposure to an index case.
 Adolescents and adults become susceptible
when immunity wanes.
Diagnosis
 Culture taken from the nose (See handout)
 Despite increasing awareness and recognition

of pertussis as a disease that affects

adolescents and adults, pertussis is
overlooked in the differential diagnosis of
cough illness in this population
Treatment
 Pertussis is one of a few bacterial infections
for which antibiotic treatment has little effect
on the course of the illness.
  Treatment lessens the severity of pertussis if

given early in disease, before the cough is

well established and usually before the illness
is recognized as pertussis
  Vaccination is the most effective strategy
 A macrolide (erythromycin, azithromycin
(Zithromax®) administered early in the course
of illness can reduce the duration and
severity of symptoms and lessen the period
of communicability
 Approximately 80%--90% of patients with
untreated pertussis will spontaneously clear
B. pertussis from the nasopharynx within 3--
4 weeks from onset of cough
 Untreated and unvaccinated infants can
remain culture-positive for >6 weeks (
Postexposure Prophylaxis
 A macrolide can be administered as
prophylaxis for close contacts of a person with
pertussis if the person has no contraindication
to its use.
 The decision to administer postexposure
chemoprophylaxis is made after considering
the infectiousness of the patient and the
intensity of the exposure, the potential
consequences of severe pertussis in the
contact, and possibilities for secondary
exposure of persons at high risk from the
contact (e.g., infants aged <12 months
 For postexposure prophylaxis, the benefits of
administering an antimicrobial agent to
reduce the risk for pertussis and its
complications should be weighed against the
potential adverse effects of the drug.
 Administration of postexposure prophylaxis

to asymptomatic household contacts within

21 days of onset of cough in the index
patient can prevent symptomatic infection.
Prevention
 This disease can be prevented with proper
immunizations using the pertussis vaccine.
This is usually part of the DTaP vaccine - or
the diphtheria, tetanus, and pertussis.
 This vaccine is usually given to children at 2,

4, 6, and 15 to 18 months of age, with a

booster at 4 to 6 years of age
Penta vaccine immunization schedule for children under one year of age

age Minimum dose

interval
between doses
6 weeks Penta vaccine 1
10 weeks 4 weeks Penta vaccine 2
14 weeks 4 weeks Penta vaccine3
 Administration of penta vaccine or DPT
vaccine the 0.5 ml dose of penta or DPT is
injected intramuscularly , usually into the
outer part of the thigh
 Booster doses after a child,s first year
 For longer –lasting protection, countries that

have reached high coverage with the primary

series of the three DPT doses may give one or
two booster doses after children reach one
year of age up to the age of seven.
 Thereafter, children should not be given
pertusis vaccine, even in combination, due to
the increased risk of adverse reactionsjjj
Adolescents
 Adolescents with pertussis are increasingly
reported across the United States
 The provisional counts were ~8000 reported

cases in adolescents in 2004

 The impact of pertussis among adolescents is
significant
 The substantial morbidity includes prolonged
cough that can last for more than 3 months
in about half of adolescents with pertussis.
 ¾ of adolescents have trouble sleeping, about
half vomit with severe paroxysms of cough
 A small percentage of adolescents lose
consciousness during these paroxysms
 About a 1/3 lose weight during the illness.
 Complications include pneumonia in 2%, rib

fractures from violent coughing in 1%, and

~1% of adolescents with pertussis are
hospitalized
 Thanks for listening and attention