During the 1900s the first epidemic of pertussis was noticed. It was a very common childhood illness. High rates of deaths were due to pertussis which is an acute infection of the respiratory tract. It was especially a serious disease in targeting infants due to their underdeveloped bodies. Around the 1940s a vaccination to prevent deaths caused by pertussis was invented and the rate of deaths lowered dramatically. However, recent cases of pertussis have been on the rise, and not only is it affecting infants and small children it is occuring in people who have been vaccinated and are ten years of age or older.
When the first pertussis vaccine became available it was a whole-cell pertussis vaccine and was developed in the 1940s. It was in widespread use by the 1980s the average incidence of pertussis had decreased to about 1/100,000 as compared to 150/100,000 during the 1920s throught the 40s. Now the pertussis vaccine is combined with diphtheria toxoid and tetanus toxoid to make the vaccination DTaP. The pertussis component of this vaccine is a more purified “acellular” version, which produces fewer side effects. In 2005, two new tetanus toxoid-diphtheria-acellular pertussis (Tdap) vaccines were licensed. These vaccines are the first acellular pertussis-containing vaccines that make it possible to vaccinate adolescents and adults against pertussis in contrast to Dtap which is for infants and young children.
Both DTaP and Tdap vaccines are “inactivated” vaccines. Inactivated vaccines do not contain live bacteria or virus and cannot reproduce, which is why multiple doses are needed to produce immunity. DTaP is for children younger than 7 years and has a higher concentration of pertussis than Tdap, which is intended for persons 10 years and older. All infants should receive DTaP vaccine as part of their routine immunization unless they have a medical reason not to. Persons 10 years and older can receive Tdap vaccine in place of a routine booster dose of adult Td vaccine.
So what is pertussis? Its etiology is a gram negative bacteria called Bordetella Pertussis. People usually contract the bacteria through the air when an infected person coughs, sneezes or comes in contact with the infected saliva. Pertussis is generally known as or called “whooping cough.” it is an exceedingly contagious disease that infects the respiratory system and is characterized by a “whooping” sound when the person inspires. The cough can lasts for weeks at a time. The severe coughing makes it extremely difficult to breath. If undetected for a long period of time it can cause serious health issues such as pneumonia, convulsions, brain damage even death.
After a person who has been exposed the incubation period, the growth of pertussis from the time bordella pertussis enters the body until signs or symptoms first appear is commonly seven to 10 days, with a range of 5-21 days. symptoms of pertussis are divided into three stages, the catarrhal, paroxysmal and the convalescent stages.
Catarrhal stage: has symptoms of a common cold and can last from 1-2 weeks and includes a runny nose, sneezing, low-grade fever, and a mild cough. Nothing to really be worried about until you see your symptoms and sickness still persist and you get to the paroxysmal stage. In this stage signs usually lasts 4-6 weeks, but can persist for up to 10 weeks. The distinguishing symptom in this stage is a numerous, loud convulsing rapid coughs. The patient usually suffers from a long inhaling effort that is characterized by a high-pitched whoop. This is where the name whooping cough came along. Little kids may also turn blue and vomit. The last stage, the convalescent stage can last 2-6 weeks or even months. Even though the cough usually disappears paroxysms may recur whenever the individual suffers any following respiratory infection. However, these individuals can still transmit the disease to others, including unimmunized or incompletely immunized infants.
Unfortunately, a steady increase in reported pertussis cases has occurred, with more cases in adults and adolescents. One may ask how come case of pertussis are on the rise again if they should have been vaccinated? Immunity to pertussis has been shown to wane 5-10 years after being vaccinated and a booster is need.
One major problem in detecting adults who see a doctor for a persistent cough may actually have pertussis, but it may go undiagnosed because symptoms are usually mild and adults are unlikely to have the classic whooping cough. This is a huge problem, because such adults may unknowingly infect unvaccinated children. To know for sure, the health care provider may take a sample of mucus from the nose nasal secretions and send it to a lab, which tests it for pertussis. While this can offer an accurate diagnosis, the test some time, and treatment is usually started before the results are ready. Some patients may have a complete blood count that shows an elevation in numbers of lymphocytes.
As we know younger kids have a greater chance of complications from pertussis than older people. The most common complication is secondary bacterial infection, which is the cause of most pertussis-related deaths. Pneumonia occurs in one out of 20 cases. Infants are also more prone to suffer from such neurologic complications as seizures and encephalopathy, probably due to the reduction of oxygen supply to the brain. Rates of hospitalization and complications increase if its an infant or toddlers as compared to an adolescent or adult. According to the Center for Disease Control, of the 100 deaths from pertussis during 2000-2004, 76 occurred in infants age one month or younger. Infants younger than age one year accounted for 19% of pertussis cases and 92% of pertussis deaths in the United States during 2000-2004.
The medication used to treat this infection are Antibiotics, which are somewhat helpful in treating pertussis. The drug of choice is usually erythromycin for four times a day for ten days. This antibiotic should also be given for 14 days to all household and other close contacts of the patient to minimize transmission, regardless of age and vaccination status. Infants with severe cases should be hospitalized. All close contacts younger than seven years of age should complete their vaccine series of DTaP if they have not already done so. If they have completed their primary four dose series, but have not had a dose within the last three years, they should be given a booster dose.
Children younger than 6 months are at particular risk because even with vaccination, protection is incomplete. Since cases of pertussis have been on the rise and reported in teens and adults, because their immunity has faded since their original vaccination. Individuals should be noticed of a booster shot to prevent the further spread of pertussis, especially to infants who have greater complications to pertussis and can lead to their demise if not treated on time.