PERTUSIS

(WHOOPING COUGH)
 Acute infectious disease of young children,
caused by Bordetella pertusis.
 Characterized by an insidious onset with mild
fever and irritating cough, gradually becoming
paroxysmal with the characteristic “whoop” (loud
crowing inspiration) often with cyanosis and
vomiting.
 The Chinese call it a “Hundred Day Cough”.
 PROPLEM STATEMENT

 Important cause of deaths in infants worldwide

 Public health concern even in countries with high
vaccination coverage
 During 2012 about 2.49 lac cases were reported
to WHO globally and the DPT3 immunization rate
was 83 percent
 CONTI..

 In India, marked decline of the disease after

launch of UIP.
 1987 -> 1.63 lac cases reported
 2014 -> 61,417 cases reported
 Showing decline of about 62.3 percent
 EPIDEMIOLOGICAL DETERMINANTS
Agent factors
a) AGENT : Bordetella pertusis (large proportion of
cases), B. parapertusis (less than 5% cases)
- Occurs in smooth and rough phases, capsulated
and non-capsulated forms, and elaborates an
exotoxin and endotoxin.
-Gram-negative, aerobic, pathogenic, encapsulated
coccobacillus
- Bacterium survives only for very short periods
outside the human body.
BORDETELLA PERTUSIS
c) SOURCE OF INFECTION : Case of pertusis, infects
only man, chronic carrier state does not exist and
no evidence that infection is subcllinical.
d) INFECTIVE MATERIAL : Nasopharyngeal and
bronchial secretions
e) INFECTIVE PERIOD : Extend from a week after
exposure to about 3 weeks after the onset of the
paroxysmal stage, most infectious during catarrhal
stage.
f) SECONDARY ATTACK RATE : 90% in unimmunized
household contacts
 HOST FACTORS
a) AGE : Disease of infants and pre-school children,
highest incidence – below the age of 5 years, Infants
below the 6 months have the highest mortality.
b) SEX : Incidence and fatality – more among female
than male children.
c) IMMUNITY : Recovery from whooping cough or
adequate immunization is followed by immunity.
Infants are susceptible to infection from birth
because maternal antibody does not appear to give
them protection.
ENVIRONMENTAL FACTORS
 Seasonal trend with more cases occurring during
winter and spring months, due to overcrowding
and indoor living, greater in lower social classes.

MODE OF TANSMISSION
 Droplet infection and direct contact

INCUBATION PERIOD
 7 to 14 days
 CLINICAL FEATURES
 B. pertusis produces a local infection; the organism
is not invasive.
 It multiplies on the surface epithelium of the
respiratory tract and causes inflammation and
necrosis of the mucosa leading to secondary
bacterial invasion.
 Three stages – in the clinical course of the disease.
 Conti..

a) CATARRHAL STAGE : Lasting for about 10 days,

characterized by insidious onset, lacrimation,
sneezing and coryza, anorexia and malaise, and a
hacking night cough that becomes diurnal.
b) PAROXYSMAL STAGE : Lasting for 2—4 weeks,
characterized by burst of rapid, consecutive coughs
followed by a deep, high-pitched inspiration
(whoop), followed by vomiting.
c) CONVALESCENT STAGE : Lasting for1-2 weeks.
 COMPLICATIONS

 Occur in 5-6 % of cases

 Bronchitis, bronchopneumonia and bronchiectasis,
subconjuctival hemorrhages, epistaxis, haemoptysis
and punctate cerebral hemorrhages which may cause
convulsions and coma.
 Incidence of pertusis-associated encephalopathy is
0.9 percent 100,000.
 In developing countries the average mortality is 3.9
percent in infants and 1 percent in children aged 1-4
yeaars.
 CONTROL OF WHOOPING COUGH

1. CASES AND CONTACTS

a) Cases :
 Early diagnosis, isolation and treatment of cases,
and disinfection of discharges from nose and
throat.
 Early diagnosis by bacteriological examination of
nose and throat secretions by naso-pharyngeal
swabs.
 Erythromycin is the drug of choice, 30-50mg/kg of
body weight in 4 divided doses for 10 days.
 Conti..

 Antibiotics may prevent or moderate clinical pertusis

when given during incubation period or in early
catarrhal stage.
 During paroxysmal stage, antimicrobial drugs may
eliminate the bacterium from the nasopharynx and
reduce transmission of disease.
 Useful in controlling secondary bacterial infections.
b) Contacts :

 Infants and young children should be kept away

from cases.
 Contacts with whooping cough, may be given
prophylactic antibiotic (erythromycin or ampicillin)
treatment for 10 days
 2. ACTIVE IMMUNIZATION

 Active immunization is the best preventive measure

for pertusis.
 The vaccine is administered in National
Immunization Schedule as combined Pentavalent
vaccine.
 Pentavalent vaccine provides protection to a child
from 5 life-threatening diseases – Diphtheria,
Pertussis, Tetanus, Hepatitis B and Hib.
 Conti..

 3 doses of pentavalent (0.5ml), Intramuscularly at

the age of 6,10 and 14 weeks.
 Booster 1st at 16-24 months and 2nd booster at 5-6
years of age, as combined DPT vaccine in NIS.
 Efficacy – 46% to 92% (avg. 85%)
 ACELLULAR PERTUSIS VACCINE
 Used for vaccination of older children and adults
 Lesser side effects
 Available preparation – aP, DTap, TdaP
 Efficacy – 54% to 89%

 The duration of protection following the primary 3

dose course in infants and 1 booster dose (1 year
later)- Average 6-12 years for both whole cell and
acellular pertusis vaccine.
 UNTOWARD REACTIONS
 Local reactions at the site of injections
 Mild fever and irritability
 Rare vaccine reactions are persistent (more than 3
hours) inconsable screaming, seizures, hypotonic
hypo-responsive episodes, anaphylactic reactions
and very rarely encephalopathy.
 CONTRAINDICATIONS

 Anaphylactic reactions
 Encephalopathy
 Personal or strong family history of epilapsy
 Convulsions
 CNS disorders
 Reaction to one of the previously given pentavalent
or triple vaccine injections.
 3. PASSIVE IMMUUNIZATION
 No evidence of its efficacy in well-controlled trials.

CONCLUSION
 Whooping cough is a disease of respiratory mucous
membrane.
 It is a bacterial and contagious disease which mainly
caused by Bordetella Pertusis.
 It mainly occur in young children (3-5 years).
 It can be prevented by active immunization.
 It is treated by DPT vaccine and antibiotics.