Whooping cough

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1. PERTUSSIS or WHOOPING COUGH MD DANISH RIZVI DEPT. COMMUNITY MD DANISH RIZVI

2. INDEX INTRODUCTION EPIDEMIOLOGICAL DETERMINANTS INCUBATION PEROID CLINICAL COURSE COMPLICATIONS TREATMENT AND CONTROL MD DANISH RIZVI

3. INTRODUCTION Pertussis is also called as Whooping cough is a highly contagious disease mainly of children caused by Bordetella pertussis. It is characterized by severe uncontrollable coughing spells which can sometimes end in a “whoop” sound when person breathes in. Also called as “100 day cough” by Chinese. MD DANISH RIZVI

4. In 2012, 2.49 cases were reported by WHO globally when the DPT immunization was 83%. In India after launch of immunization programme in 1987, the reported cases dropped from 1.63 lakh to only 36,661 cases in 2013 ( 77% decline) Underlying malnutrition and other respiratory infections in children make then prone to this disease. Recently the disease shows increase incidence in older children, adolescents and adults.(21% adults had pertussis after serological studies of adults with cough for more than 2 weeks) MD DANISH RIZVI

5. Epidemiological Determinants AGENT FACTORS- Agent -Causative agent is Bordetella pertussis. Also caused by B.parapertussis, Viruses(parainfluenzae, adenovirus) MD DANISH RIZVI

6. Source of infection- Only man is the known source of infection. Pervious case of pertussis which may be mild, missed and unrecognised case is usually the source of infection. No chronic carrier state exist Infective materia l –Nasopharyngeal and bronchial secretion. Fomites contaminated by such discharge are also infective. MD DANISH RIZVI

7. Infective period- Catarrhal stage most infective. Extends from week after exposure to about 3 weeks after onset of paroxysmal stage. Secondary attack rate- Average 90% in unimmunized people. MD DANISH RIZVI

8. HOST FACTORS Age- Infants and pre-school (<5 years) - Developing countries (20-30 months) and developed countries (50 months) -Highest mortality below 6 months. Sex- More common among females. Immunity-Immunity develops after a case or immunization. No cross immunity. Secondary attack occur in declining immune person. MD DANISH RIZVI

9. ENVIRONMENT More cases occur during winter and spring. Lower socio-economic group more prone than well to do groups due to overcrowding. MD DANISH RIZVI

10. INCUBATION PEROID Usually 7-14 days but not more than 3 weeks MD DANISH RIZVI

11. CLINICAL COURSE Causes local infection by multiplying in the surface epithelium of respiratory mucosa. Leads to inflammation and necrosis of mucosa. Occurs in 3 stages- Catarrhal stage Paroxysmal stage Convalescent stage MD DANISH RIZVI

12. 1. Catarrhal stage- - Lasts for 10 days. - Characterized by: Insidious onset Lacrimation Sneezing Coryza A n ore x ia Malaise Hacking night cough that becomes diurnal MD DANISH RIZVI

13. 2. Paroxysmal stage -Lasts for 2-4 weeks -Characterized by burst of rapid, consecutive coughs followed by a deep, deep pitched inspiration (whoop) - Followed by vomiting In infants- Causes cyanosis and apnoea In adults and adolescents- Uncharacteristic,persistent cough MD DANISH RIZVI

14. 3. Convalescent stage- Lasts for 1-2 weeks Decrease in paroxysms of coughing both in freq and severity Cessation of Vomiting MD DANISH RIZVI

15. Com p licat i ons Occurs in 5-6% cases Frequent in infants aged less than 6 months Mainly- Bronchitis - Bronchopneumonia (5.2%) -Bronchiectasis -Subconjuctival hemorrhage -Epistaxis -Heomptysis -Punctate cerebral hemorrhage -Coma and convulsions MD DANISH RIZVI

16. Control of whooping cough - Isolation of case 30-50 mg/kg for 10 days Septran , Ampicillin and Cases and contacts- Cases- Early diagnosis by bacteriological exam. of nose and throat secretions (60% chances within 10-14 days from onset) Given during incubation or in early catarrhal stage to - Treatment of case- Erythromyc p i r n event or moderate clinical pertussis. During paroxysmal stage only eliminate bacteria Tetracycline can also be used. from nasopharynx eliminating transmission MD DANISH RIZVI

17. 2.Contacts -Isolation of case -Prophylactic antibiotics (Erythromycin or Ampicillin ) treatment for 10 days to prevent establishment of case in exposed infants. MD DANISH RIZVI

18. Active immunization - Covered under National Immunization Programme -Combined as DPT, DTWP or DTaP vaccine. -Administered as 3 dose ( each dose 0.5 ml) IM at 1 month interval starting at 6 weeks. -Booster dose at 18-24 months -Acellular vaccine for older children and adults MD DANISH RIZVI

19. Efficacy 85% Duration of protection 6-12 years following complete dose+ booster HIV positive individuals should also be immunized Adverse reactions- Early vaccine caused screaming and collapse. -Give rise to local reactions at site of injection, mild fever and irritability -Rare vaccine reaction are- Inconsolable screaming, seizures, hypotonic hypo- responsive episode, MD DANISH RIZVI

20. Contraindications- Anaphylactic reactions, encephalopathy, history of epilepsy, convulsions or similar CNS disorders , any febrile episode and reaction to previous triple vaccine Passive immunization- Hyperimmune globulin is given but efficacy no established yet. MD DANISH RIZVI

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