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Pertussis
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Routine immunization of infants and children with acellular Pertussis (aP) vaccine is recommended at 2, 4, 6 and 15-18 months of age with a booster dose at 4-6 years of age. It is given in a combination with Diphtheria and Tetanus vaccines called DTaP. The effectiveness of the vaccine in children who have received at least 3 doses is estimated to be 80%; and protection is even greater against severe disease. Protection will begin to diminish after about 3 years. Persons who experience pertussis after immunization usually have a milder case. DTaP vaccine is currently recommended for children 2 months through 6 years of age.
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Pertussis is a vaccine-preventable disease with a high rate of complications, especially in young children. It often presents in an atypical fashion in adults and adolescents, making diagnosis difficult. This report describes a cluster of linked cases of three adults and one infant in a family, spread across the United Kingdom (UK). The initial follow-up was of a 20-year-old student with clinical symptoms of pertussis. This diagnosis led to the discovery of two other unvaccinated adult family members with symptoms that fit the case definition for pertussis and a laboratory-confirmed tertiary case in an unvaccinated infant who had to be hospitalised. This report aims to act as a reminder for including pertussis as a differential diagnosis in patients with a long duration of respiratory symptoms and highlights the importance of rapidly identifying and managing close contacts of cases.
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Pertussis (whooping cough) is a highly communicable infectious disease caused by the bacterium Bordetella pertussis. Pertussis is characterized by spasms (paroxysms) of severe coughing. The cough spasms are often followed by vomiting and by a characteristic inspiratory "whoop." The incubation period is about 7 to 20 days. Pertussis starts with symptoms similar to those of a minor upper respiratory infection and is followed by several weeks of episodes of paroxysmal coughing. Pertussis can occur among persons of any age, regardless of vaccination status, and may be relatively common among adolescents and adults in the United States, although infants less than one year old have the highest rates of reported disease.
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Pertussis begins as a mild upper respiratory infection. The first symptoms are like those of a cold, including sneezing, runny nose, low-grade fever, and a mild cough. Within 2 weeks, the cough becomes much worse. Children with pertussis often have episodes of rapid, spasmodic coughing followed by a characteristic intake of breath that sounds like a "whoop." The violent coughing spells are worse at night and can last for as long as 1 to 2 months. The spells can make it hard for a child to eat, drink, or even breathe.
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Pertussis is caused by Bordetella pertussis, first isolated in 1906 by bacteriologists Bordet and Gengou (Cherry, 1996). Despite intensive study since that time, much remains unknown regarding the organism's biology and pathogenesis. B. pertussis, a polymorphic bacillus, contains a number of allergenic components. Of these, the effect of the component pertussis toxin is thought to be associated with the rapid adverse events occurring after vaccination, although the pathophysiologic responses related to specific clinical symptoms is not clearly defined (Pittman, 1986).
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Pertussis is easily spread when an infected person coughs or sneezes. Pertussis can cause spells of violent coughing and choking in young children, making it hard to drink, eat, or even breathe. Children often make a "whooping" noise when they breathe in after a hard coughing attack, which is why this disease is often called whooping cough. The cough can last for weeks. This disease is most serious for babies under a year old. Pertussis may cause serious health problems: about 1 child in 10 with pertussis ... gets pneumonia; about 20 in every 1,000 will have convulsions; and in 4 of every 1,000 the brain will be affected.
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Pertussis