Pertussis (Whooping Cough)

Description

Whooping cough (or pertussis) is a highly contagious bacterial respiratory infectiona. It can affect people of all ages. For adolescents and adults the infection may only be a persistent cough, however for young children whooping cough can be life threatening. The cough can obstruct a baby’s breathing and they may lack oxygen and become blue. Complications of the disease include hypoxic encephalopathy (lack of oxygen to the brain) leading to brain damage and possibly death.

Symptoms

Whooping cough may start like a cold, with a runny nose and sneezing, and then the characteristic cough develops. These coughing bouts can be very severe and frightening, and may end with a crowing noise (the whoop) as the patient breaths in after the paroxysmal cough. This occurs as air is drawn back into the chest, and can be followed by vomiting or gagging. In young infants, as well as older children and adults, the typical symptoms may not be present.

After exposure to the bacteria, it usually takes nine to ten days to become ill.

Transmission

The bacteria are spread by an infected person coughing or sneezing. Direct contact with infected secretions from the mouth or nose can also pass on the infection.

A person is highly infectious for the first two weeks of their cough. After three weeks of coughing, the person is regarded as non-infectious, even though coughing may last up to three months.

Treatment

Treatment is a full course of antibiotics which reduces the time a person is infectious to others. Antibiotics need to be given within 21 days of the start of general symptoms or within 14 days of the start of the cough. Antibiotics reduce symptoms if given when infection is developing, after contact with a person with pertussis and in the early coughing stage.

Not all people who have close contact with an infected person with whooping cough need treatment. However, because infants are at a higher risk of severe complications if they develop whooping cough, a full course of antibiotics is recommended for the following people in the same house as a person with whooping cough (if the infected person has been coughing less than 21 days). This includes:

any baby less than 12 months of age regardless of their vaccination status
any child between 12-24 months of age who has received less than three doses of a whooping cough vaccine
any woman in the last month of pregnancy
any child or adult who attends or works in a childcare centre.
If a child with whooping cough attends childcare and belongs to the infant group (less than 12 months of age), the other infants in that group should be given antibiotics if the infected child has been coughing less than 14 days.

Control

A person with whooping cough should stay away from work, school and child-care until they have had full course of antibiotics, or until 21 days after the beginning of the coughing or until the end of coughing, which ever comes first.

Household contacts, who have received less than three doses of whooping cough vaccine, should be excluded from child-care centres until they have taken a full course of antibiotics or for 14 days after the last exposure to infection.

Prevention

Whooping cough can be prevented by vaccination. The whooping cough (pertussis) vaccine is combined together with diphtheria, tetanus and inactivated poliomyelitis vaccine (DTPa-IPV).

DTPa-IPV vaccine is recommended and provided free for:

all babies at 2, 4 and 6 months of age; and
a booster at 4 years of age.
The protection provided by childhood vaccination gradually reduces over time, leaving adolescents and adults potentially at risk of catching the disease. An adult-adolescent whooping cough vaccine, combined with diphtheria and tetanus vaccine (dTpa), is now available.

A single booster dose of dTpa is recommended and provided free for:

adolescents at 15 years of age, or year 10 students if vaccinated in a school based vaccination program.

for both partners planning pregnancy, or for both parents as soon as possible after delivery of an infant;
adults working with young children especially health-care and child-care workers;
any adult requesting a booster dose of dTpa, provided they have received three previous doses of DTP; and
dTpa may be used instead of ADT vaccine at 50 years of age.

Information drawn from Queensland Health website

For more detailed information please visit the Australian Immunisation Handbook section on pertussis.