C05 P12 WHOOPING COUGH Community Medicine.ppt

Community Medicine

1. WHOOPINGWHOOPING
COUGHCOUGH
(PERTUSSIS)(PERTUSSIS)
By By
k.prashanth, 2k4k.prashanth, 2k4
roll no 46roll no 46

2. Whooping cough (pertussis)Whooping cough (pertussis)
is an acute infectious is an acute infectious
disease, disease,
usually of young children usually of young children
caused by the bacteria caused by the bacteria
bordetellabordetella pertussispertussis..
The Chinese call it a The Chinese call it a
“Hundred Day Cough”.“Hundred Day Cough”.

3. AGENT FACTORSAGENT FACTORS
AgentAgent
•Bordetella pertussisBordetella pertussis
•Small gram negativeSmall gram negative
•Aerobic coccobacillusAerobic coccobacillus
•Singly or in pairsSingly or in pairs

Clinical diseaseClinical disease – – encapsulatedencapsulated phasephase 1 1
strainsstrains. .

4. Antigenically complex Antigenically complex
3 major agglutinogens 1,2,3 and3 major agglutinogens 1,2,3 and
several minor ones.several minor ones.

5. SourceSource
•B.pertussis infects only man B.pertussis infects only man
•S.O.I is a case of pertussisS.O.I is a case of pertussis
Infective materialInfective material
•Nasopharyngeal and bronchial secretions Nasopharyngeal and bronchial secretions
– bacilli occurs more in number.– bacilli occurs more in number.
Infective periodInfective period
•Catarrhal stageCatarrhal stage

6. HOST FACTORSHOST FACTORS
AgeAge
•Disease of infants and Disease of infants and
preschool childrenpreschool children
•Highest incidence – below 5 years Highest incidence – below 5 years
•High mortality - Infant below 6 months High mortality - Infant below 6 months
SexSex
•Incidence and fatality more among Incidence and fatality more among
femalesfemales

7. ImmunityImmunity
•Recovery and adequate immunization.Recovery and adequate immunization.
•Second attacks – declining immunity – Second attacks – declining immunity –
mild.mild.
•Infants susceptible – maternal antibodies Infants susceptible – maternal antibodies
does not give protection.does not give protection.

8. ENVIRONMENTAL FACTORSENVIRONMENTAL FACTORS

Through out the year Through out the year

More cases – winter and springMore cases – winter and spring

Risk greater in lower social classesRisk greater in lower social classes

9. Spreads through Droplet infection and Spreads through Droplet infection and
direct contact.direct contact.
Adults and older children with Adults and older children with
unrecognized pertussis often spread the unrecognized pertussis often spread the
infection.infection.

10. INCUBATION PERIODINCUBATION PERIOD
Usually 7 to 14 days,Usually 7 to 14 days,
but not more than 3 weeks.but not more than 3 weeks.

11. How infection How infection
develops -develops -

12. SYMPTOMSSYMPTOMS
Intense coughIntense cough –striking characteristic. –striking characteristic.

Appear 7 to 10 days, can be as long as 21 Appear 7 to 10 days, can be as long as 21
days after exposure.days after exposure.

13. Three stages – The illness generally Three stages – The illness generally
lasts 4 - 6 weeks.lasts 4 - 6 weeks.
a) a) catarrhal stagecatarrhal stage
b) b) paroxysmal stageparoxysmal stage
c) c) convalescent stageconvalescent stage

14. a)a)Catarrhal stageCatarrhal stage
•mild cough mild cough
•running nose andrunning nose and

•low grade feverlow grade fever
•lasts for about 10 dayslasts for about 10 days

15. b)b)paroxysmal stageparoxysmal stage
•cough gets worse. cough gets worse.
•cough is dry and harsh.cough is dry and harsh.
•cough ends with a cough ends with a whoop whoop sound on sound on
inspiration.inspiration.
•child may vomit with the coughing and child may vomit with the coughing and
appear to be strangling on the vomit.appear to be strangling on the vomit.
•cough can be started by many factors, cough can be started by many factors,
including feeding, crying, or playing.including feeding, crying, or playing.

16. •During these coughing spells – During these coughing spells –
•face turn blue, eyes bulge, tongue protrude face turn blue, eyes bulge, tongue protrude
and vomiting may accompany.and vomiting may accompany.
This stage may last 2 to 4 weeks. This stage may last 2 to 4 weeks.

17. c)c)Convalescent stageConvalescent stage
•Vomiting and the whooping cough cease Vomiting and the whooping cough cease
first.first.
•The cough usually decreases around the The cough usually decreases around the
sixth week, but may continue on sixth week, but may continue on
occasion for the next one to 2 months.occasion for the next one to 2 months.

18. COMPLICATIONSCOMPLICATIONS
Teenagers and adults - recover from whooping Teenagers and adults - recover from whooping
cough without complications.cough without complications.
But in infants - especially under the age of 2 But in infants - especially under the age of 2
complications are more severe and may includecomplications are more severe and may include: :
•BronchitisBronchitis
•BronchopneumoniaBronchopneumonia
•BronchiectasisBronchiectasis
•Sub Conjunctival hemorrhagesSub Conjunctival hemorrhages
•EpistaxisEpistaxis
•HemoptysisHemoptysis
•Punctuate cerebral hemorrhagesPunctuate cerebral hemorrhages
•SeizuresSeizures
•Brain damageBrain damage
•ConvulsionsConvulsions and and comacoma

19. PneumoniaPneumonia - Most serious potential - Most serious potential
complication, causing more than 90 complication, causing more than 90
percent of the deaths from the disease in percent of the deaths from the disease in
children under the age of 3. children under the age of 3.

20. DiagnosisDiagnosis
DiagnosisDiagnosis – –
based on based on symptomssymptoms,,
physical examinationphysical examination,,
and culture or and culture or DFADFA testing of testing of
nasopharyngeal secretion.nasopharyngeal secretion.

21. TREATMENTTREATMENT
If started early - If started early - AntibioticsAntibiotics such as such as
erythromycinerythromycin and and amoxicillinamoxicillin can make can make
the symptoms go away more quickly.
 
the symptoms go away more quickly.
 
Unfortunately, most patients are diagnosed Unfortunately, most patients are diagnosed
too late,
 when antibiotics aren't very
too late,
 when antibiotics aren't very
effective.
 
effective.
 

22. CONTROLCONTROL
1.1.Cases and contactsCases and contacts
i.i.CasesCases
•Early diagnosis, isolation and treatment Early diagnosis, isolation and treatment
of cases and disinfection of discharges. of cases and disinfection of discharges.
•Antibiotics – erythromycin , ampicilin, Antibiotics – erythromycin , ampicilin,
septran or tetracycline useful in septran or tetracycline useful in
controlling secondary bacterial infection.controlling secondary bacterial infection.

23. ii.ii.ContactsContacts
•Infants and young children kept away.Infants and young children kept away.
•Those known to have been in contact –Those known to have been in contact –
prophylactic antibiotic – days.prophylactic antibiotic – days.

24. 2.2.Active immunizationActive immunization
i.i.DPTDPT
•3 primary doses of DPT3 primary doses of DPT
vaccine intramuscularly at 4 vaccine intramuscularly at 4
weeks interval starting at 6 weeks.weeks interval starting at 6 weeks.
•First booster dose - 15-18 monthsFirst booster dose - 15-18 months
•Second booster dose – 5- 6 years Second booster dose – 5- 6 years
•If pertussis is prevalent – started earlier at age of If pertussis is prevalent – started earlier at age of
1 month.1 month.

25. Dr. Pearl Kendrick (1890-1980)Dr. Pearl Kendrick (1890-1980)
Dr. Grace Eldering (1900-1988)Dr. Grace Eldering (1900-1988)
developed the first successful whooping developed the first successful whooping
cough vaccine in 1938. cough vaccine in 1938.

26. ii.ii.Pertussis vaccinePertussis vaccine
•Killed whole cell preparation.Killed whole cell preparation.
•3 doses at intervals – 6- 8 weeks starting at 2 3 doses at intervals – 6- 8 weeks starting at 2
or 3 months old.or 3 months old.
•Gradual drop in immunity.Gradual drop in immunity.
•2 boosters – spaced at 3 year intervals.2 boosters – spaced at 3 year intervals.
•Local reactions at the site of injection , mild Local reactions at the site of injection , mild
fever and irritability.fever and irritability.

27. 3.3.Passive immunizationPassive immunization
•The merit of hyper immune globulin yet to be The merit of hyper immune globulin yet to be
established.established.
•So for , there is no evidence of its efficacy in So for , there is no evidence of its efficacy in
well-controlled trials.well-controlled trials.