Infectious diseases Whooping cough: public health management and guidance - Digital Intent


Thursday, 31 August 2017

Infectious diseases Whooping cough: public health management and guidance

Pertussis (whooping cough) is a highly contagious, acute bacterial infection. It can affect people of all ages, but is especially dangerous in vulnerable groups, such as unimmunised infants.

Whooping cough (also called pertussis after its causative agent) is a resurgent disease in the UK. A significant increase in observed cases nationally during 2011 led to the declaration of a national outbreak in April 2012[1]. In 2012, there were 9,367 confirmed cases in England, a ten-fold increase on previous years[2]. Historically, despite its very high transmissibility, pertussis has been well controlled since the routine introduction of acellular vaccination in 2004, during a period of sustained high vaccine coverage[3]. There were previous, large epidemics in the 1970s and 1980s owing to drops in vaccine coverage over safety concerns of the previously used whole-cell pertussis vaccine that was introduced in 1952. The recent national increase in observed cases is not unique to the UK and is thought to be partly because of the change in vaccine; acellular versions afford a shorter duration of protection, with less protection again colonisation and, therefore, transmission of bacteria[4]. Acellular vaccines remain highly effective against infection and severe disease.

Patients infected with the causative agent of whooping cough, Bordetella pertussis, suffer from a prolonged cough illness without fever. Characteristically an illness of older children and adults, it can affect patients of all age groups with severe disease, which includes apnoeic episodes, pneumonia and neurological complications more common in young children, often with high mortality if left untreated. The classic inspiratory ‘whoop’ follows paroxysms of coughing, which begins at week 1–2 of illness and increases throughout the 1–2 months of illness following a 9–10 day incubation[5] (see Box 1: Clinical symptoms of whooping cough).

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