Pertussis

Pertussis – AKA Whooping Cough

  • Causative organism: Gram-negative bacterium Bordetella Pertussis
  • Incubation period: 10 – 14 days
  • Immunisations
    • 2, 3, 4 months
    • 3 – 5years
  • Pregnant women are vaccinated as newborns are particularly vulnerable
  • Infection and vaccination do not give lifelong protection – so adults may get whooping cough despite full vaccinations
  • There’s about 1000 cases reported in the UK each year

Clinically:

  • 2 -3 days of coryzal symptoms, then…
  • coughing bouts, usually worse at night and after feeding, may result in vomiting and central cyansosi
  • inspiratory whoop: not always present (caused by force inspiration against a closed glottis)
  • Persistent coughing can result in
    • subconjunctival haemorrhage
    • occasionally anoxia leading to syncope and seizures
  • Symptoms last 10 -14 weeks
  • More severe in infants
  • theres marked lymphocytosis

Diagnosis

  • nasal swab for Bordetella Pertussis – but this can take several days to come back
  • PCR and serology are now increasingly available / widespread

Managment

  • Oral macrolide
    • Clarithromycin
    • Azithromycin
    • Erythromycin
  • This is useful if the onset of the cough is within the previous 21 days
  • This eradicates the organism and reduces the spread

Complications

  • subconjunctival haemorrhage
  • pneumonia
  • bronchiectasis
  • seizures

Vaccination Of Pregnant Women

  • In 2012 14 newborn infants died of whooping cough from one outbreak
  • The number of cases was successfully reduced with a temporary vaccination programme
  • The vaccine is about 90% effective at preventing newborns developing int
  • In 2014, the decision was made to extend this vaccination to all pregnant women
  • This decision was made because of the uncertainty about when another outbreak would occur
  • Women who are 30 – 32 weeks pregnant will be offered the vaccine