Epidemiology and Control Measure for Pertussis whooping c

Pertussis, also known as whooping cough is a highly contagious bacterial disease mainly caused by Bordetella pertussis.

1. PERTUSSIS /WHOOPING COUGH AB RAJAR ASSOCIATE PROFESSOR COMMUNITY MEDICNE M UHAMMAD MEDICAL COLLEGE.MPK

2. INTRODUCTION Pertussis, also known as whooping cough is a highly contagious bacterial disease mainly caused by Bordetella pertussis . It's characterized by severe coughing spells , which can sometimes end in a "whooping " sound when the person breathes in. Habbit pattern of coughing may longer or subsequent weeks & month, so Chinese call it; ‘’’’100 DAYS COUGH’’’

3. DEFINITION Pertussis is acute highly contagious disease which cause classic spasm (paroxyms) of uncontrollable coughing, that is violent and persistence followed by a sharp, high pitched intake of air which create characteristic “ WHOOP ” sound. Children who have typically illness of pertussis try to take deep breath between cough result in whooping sound.

4. EPIDEMIOLOGY PRIMARY DETERMINANTS: The Agent Factors are: Bordetella Pertussis or Pertussis Bacillus 95% Bordetella Para Pertussis 5%. Others are: Haemophilus Haemolyticus Adeno Virus Bronchi Septica SECONDARY DÉTERMINANTS: Overcrowding Poor hygiène Poor nutrition. Winter Season

5. AGENT FACTORS SOURCE OF INFECTION: Case of pertussis.(A chronic carrier does not exist) INFECTIVE MATERIAL: 1)Nasopharyngeal Secretions. 2)Bronchial Secretions. 3)Objects freshly contaminated by such discharges.

6. AGENT FACTORS PERIOD OF COMMUNICABILITY: From 7days after exposure to about 3wks after the onset of paroxysmal stage, being most infectious during the catarrhal stage. INCUBATION PERIOD: 7-21(7-14)days.

7. MODE OF TRANSMISSION DIRECT: By droplet spread through direct contact with an infected person . It spreads through close contact with oral secretions or respiratory droplets. It can also be spread through sneezes. INDIRECT : By contact with articles freshly soiled with discharges of the pt.

8. HOST FACTORS: AGE : Infants & preschool children (below 5yrs usually 4-7months) & may occur in infants, new born, pregnant lady. SEX/GENDER : Female>male . [It is more common in females then males] IMMUNITY : Infants are susceptible to infection from birth because maternal antibody does not appear to give them protection. One attack of the disease confers life long immunity.

9. ENVIORNMENTAL FACTOR Pertussis spread throughout year but more cases found in winter/spring season. Over crowding place. Low sanitation area. Poor environmental hygiene. Person with decreased immunity. Unimmunized persons against whooping cough.

10. PATHOGENESIS Causative Agent(B- Pertussis) Liberates numbers of antigen & toxins Pathological changes in the respiratory tract. (Nasopharynx to Bronchioles) Inflammatory response to mucosa & secretion appear Local epithelium damage & symptom appear PERTUSIS DISEASE

11. CLINICAL MENIFESTATION Clinical manifestation include ‘3’ stages; 1. CATARRHAL STAGE (Pre paroxysmal stage, 0-2 weeks) 2. PAROXYSMAL STAGE (Spasmodic stage, 2-4 weeks) 3. CONVALESCENT STAGE (Last 2 weeks)

12. STAGE-I CATARRHAL STAGE CATARRHAL SYMPTOMS APPEAR THAT ARE: Fever. Rhinitis. Sneezing. Anorexia. Nausea & Vomiting . Lacrimation. Irritating cough at night (nocturnal but later become diurnal)

13. STAGE-II PAROXYMAL STAGE Cough means in paroxysms (repeating) & is accompanied by vomiting. A typical attack consist of repeated series of many cough in expiration followed by sudden deep, violent inspiration with characterize crowing sound “WHOOP” . Ulcer of franulum of tongue . Sweating, Congestion of neck & scalp vein. Patient appears suffocated with congested (red) face with or without cyanosis . Mouth opened, periorbital edema Sub conjuctional hemorrhage Convulsion may be present.

14. SUBCONJUCTIVAL HAEMORRHRGE

15. ULCER OF LINGUAL FRANULUM

16. PERIORBITAL OEDEMA

17. STAGE-III CONVULSCENT STAGE Disturbing cough & vomiting stops and apatite too imprones .( start of hungerness) Habit pattern of coughing may be longer to several weeks & month.

18. COMPLICATIONS Otitis media is quite frequent. Respiratory complications are: Pneumonia (specially in infants) Atelectasis Bronchictaxis Emphysema Neurological complication Intra cranial hage (Hemorrhage) Seizures (due to cerebral hypoxia) Paralysis Hemiplegia Encephalopathy (Encephalitis) (Due to cerebral anoxia)

19. COMPLICATIONS Rupture of diaphragm. Rectal prolapse, umbilical & inguinal hernia over whelming strain of violent cough. Malnutrition due to vomiting.

20. DIAGNOSTIC Pertussis is difficult to diagnose because coughing may be due to common cold, bronchitis or chest infection . For accurate diagnosis : CBC (Lymphocytosis increased) Chest X-Ray (Perihilar infiltration, atelectasis, emphysema) ELISA (To detect IgM, IgG, IgA) Nasopharyngeal swab (Mainly in stage-I)

21. PREVENTION & CONTROL Active immunization is best preventive measure for pertussis . DPT Vaccine = 0.5 ml. IM, 5 dose DPT 1st dose 6 weeks. DPT 2nd dose 10 weeks. DPT 3rd dose 14 weeks. Booster dose 20 -23 month.

22. PERTUSSIS VACCINE Pertussis is given as mixed vaccine as DPT. Types of Vaccine: D & T are toxoids. P is killed. Pertussis vaccine is not given after the age of 24 months because of neurological complications such as: Encephalitis Prolonged convulsions. Infantile spasms . Reye’s Syndrome.

23. CHEMOPROPHYLAXIS GOALS OF THERAPY ARE TO L imit the number of paroxysms, T o observe the severity of the cough, T o provide assistance when necessary. Macrolides are preferred agents {Erythromycin, Azithromycin. Clarithromycin }. Erythromycin should be given to contacts for 10 days particularly those under 2 years.

24. ERYTHROMYCIN

25. AZITHROMYCIN

26. CLARITHROMYCIN

27. HEALTH EDUCATION Emphasis should be placed on minimizing exposure to susceptible person, specially infant. Isolation & restriction of case , should be excluded from work, school, preschool & child care centers. Regular health check up. Educate pregnant women to keep distance to such cases. Active immunization .

28. THANK YOU FOR SUCH ATTENTION…!!!