Bordetella pertussis: Control of whooping cough
Control of whooping cough
- Management of cases and contacts
- Prevention by active immunization
1. Management of cases and contacts
Cases:
- Early diagnosis:
- Nasopharyngeal swab culture
- Isolation
- 4 weeks or until paroxysms cease
- Treatment
- Erythromycin is the DOC.
- Alternatives are ampicillin, tetracyclin & septran.
- Disinfection of discharges from nose and throat.
Contacts:
- Infant and young children should be kept away from the cases
- Those who are exposed
- 10 days erythromycin
2. Prevention by active immunization
- There are two vaccines:
1. Whole cell vaccine
- Killed vaccine containing inactivated B. pertussis organisms.
The adverse effect with pertussis (used in DPT)
- Local pain, swelling, redness
- Fever
- Convulsion
- Anaphylaxis
- Hypotensive, hyporesponsive episode
- infant death syndrome, and autism.
- Pertussis vaccination can complicate the already apparent abnormalities and their management.
Contraindication
- Progressive neurological disease (Relative)
- Immediate anaphylaxis
- Encephalopathy
- Persistent Inconsable cry
- Hypotensive – hyporesponsive episode
- Contraindicated in individual > 7 year age.
2. Acellular vaccine
- Five antigens purified from the organism:
- Chemically or genetically detoxified pertussis toxin (PT toxoid).
- Filamentous hemagglutinin
- 69k Da outer membrane protein ( also known as pertactin)
- Fimbrial-2antigen
- Fimbrial-3 antigens.
- May provide protection against disease but not prevention against infection.
- It can create career form in adults which can affect the infants.
Immunization:
- The vaccine is usually administered in the national childhood immunization programme as combined DPT.
- 3 doses are administered at one month interval starting at the age of 6 weeks.
- A booster is given at 18-24 months.
- The severity of pertussis infection decreases with age
- The pertussis component in DPT vaccine is not recommended after the age of 6 years.
- Therefore children over the age of 5 years who have not received DPT:
- 2 doses of DT vaccine, 4 weeks apart
- Booster dose 6 months to 1 year later.
Threshold level of herd immunity:
- 92-94%
Secondary attack rate of pertussis :
- SAR in unimmunization household contacts of pertussis 90 %
Exam Question
1. Management of cases and contacts
Cases:
- Erythromycin is the DOC.
2. Prevention by active immunization
- There are two vaccines:
1. Whole cell vaccine
The adverse effect with pertussis (used in DPT)
- Local pain, swelling, redness
- Fever
- Convulsion
- Anaphylaxis
- Hypotensive, hyporesponsive episode
- infant death syndrome, and autism.
- Pertussis vaccination can complicate the already apparent abnormalities and their management.
Contraindication
-
- Progressive neurological disease (Relative)
- Immediate anaphylaxis
- Encephalopathy
- Contraindicated in individual > 7 year age.
2. Acellular vaccine
- Five antigens purified from the organism:
- Chemically or genetically detoxified pertussis toxin (PT toxoid).
- Filamentous hemagglutinin
- 69k Da outer membrane protein ( also known as pertactin)
- Fimbrial-2antigen
- Fimbrial-3 antigens.
- May provide protection against disease but not prevention against infection.
- It can create career form in adults which can affect the infants.
Immunization:
- The pertussis component in DPT vaccine is not recommended after the age of 6 years.
Threshold level of herd immunity:
- 92-94%
Secondary attack rate of pertussis :
- SAR in unimmunization household contacts of pertussis 90 %
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