Pertussis: The fatal cough

This image is the Pertussis bacteria.

You may have read or heard of whooping cough or pertussis, and you may also be wondering why we should be worried about it when all our children should be immunised against it.

The truth is, the immunity to pertussis from vaccination wanes with age, leaving many adults and adolescents unprotected. It is these adults who will infect young infants, who then end up with complications of pertussis.

Pertussis is caused by the bacterium Bordetella pertussis, which is highly infectious.

It can affect all age groups, but infants below the age of one are at highest risk of severe illness, complications and death.

Pertussis is also difficult to diagnose as the early symptoms of this disease resemble that of the common cold or bronchitis. It is a dangerous disease, and can be fatal in very young children. However, it is just as easily prevented.

Passing pertussis around

Whooping cough or pertussis is easily spread through contact with fluids from the nose or mouth from an infected person. You can get infected with this bacteria if your hands touch these fluids or you might spread it to someone else through contact with the nose or mouth.

Furthermore, coughing or sneezing can launch small droplets of mucous from the nose or lungs into the air, which then infect those who breathe in these droplets.

Symptoms of whooping cough usually appear seven to 14 days after a person is infected, and in some people, symptoms could take up to three weeks to appear. In the beginning, most people have symptoms that are similar to a common cold, including a runny nose, sneezing, and a slight fever, followed by a dry cough a few days later.

Over time, the cough becomes more severe, and those infected may experience:

·Coughing spells that are long and hard, causing difficulty in breathing.

·A distinctive "whoop" sound when breathing in at the end of a coughing fit.

·Turning blue during an attack due to lack of oxygen caused by the inability to inhale during bouts of coughing.

·Vomiting and exhaustion following episodes of coughing.

·Feeling normal in between coughing spells.

·Worse coughing fits at night.

How much damage can whooping cough cause?

Pertussis can cause severe coughing fits that could result in a cracked or broken rib. Complications occur in 5-6 per cent of cases.

The most common complication that results from pertussis is secondary bacterial pneumonia, an infection of the lungs. This pneumonia cause the majority of whooping cough-related deaths. Young children and babies, especially those younger than two years, are at the highest risk for complications.

In addition, pertussis could also lead to other complications, which include:

·Small, red spots on the face, chest, abdomen or back, caused by burst blood vessels from coughing.

·Bruises, nosebleeds and bleeding into the whites of the eye.

·Ear infections.

·Weight loss and dehydration due to vomiting.

·Apnoea, which are pauses in breathing.

·Widening of the airways, causing extra mucous to form and collect in parts of the airways, making the lungs prone to infection.

·Lack of oxygen to the brain, which may cause fits, or in some rare cases, brain damage.

·A lump in the abdomen or groin, known as a hernia, which occurs when part of the bowel pushes through a weakness in the muscles of the abdominal wall.

According to the US Centers for Disease Control and Prevention (CDC), 66 deaths due to pertussis were reported in the years 2004-2005, with 56 of these children under the age of three months. In most cases, the deaths occurred in children who were not vaccinated, or those who were too young to be vaccinated.

Children who suffered pertussis as babies may subsequently have a fragile respiratory system and weakened immunity.

Preventing pertussis

Pertussis can be treated with appropriate antibiotics, plenty of bed rest, and fluids. However, in young children and infants, this may not be enough. The best way to prevent pertussis from developing in the first place is through vaccination.

Immunisation through vaccines are 80-90 per cent effective in protecting against this disease.

In Malaysia, all babies should receive the whole series of the DTaP (Diptheria-Tetanus-acellular Pertussis) vaccination, mandatory under the Health Ministry. Infants are given the vaccine at two, three, and five months, plus a booster shot at 18 months of age.

However, the protective effects of the vaccine typically only last four to 12 years, and adolescents and adults have to be re-vaccinated against the disease.

It is advisable that they are vaccinated with the Tdap (tetanus toxoid, reduced diphtheria toxoid and acellular pertussis) vaccine as a booster shot to reinforce immunity. Although the Tdap vaccine has lower antigens of diphtheria and pertussis, they are just enough to boost immunity against pertussis in adolescents and adults.

The booster shot is especially important for adults who come into close contact with babies younger than 12 months to prevent passing on the disease.

Furthermore, this booster shot is also recommended in children aged four to six years, adolescents aged 11-18 years, as well as adults aged 19-64 years.

All individuals handling or taking care of infants and children should be vaccinated with Tdap. These include parents, grandparents, day care employees, nurses and other related health professionals and pre-school teachers.

If you are pregnant and want to be vaccinated against whooping cough, it is advisable to wait until the second or third trimester before getting the vaccination.

In any event, do consult a doctor or paediatrician for the best time to get vaccinated.

Are there any side effects?

With any vaccination, parents are often concerned about any side effects that may result from the vaccine. Children and adults alike who receive the DTaP vaccination may have local reactions, which include tenderness, pain, redness or swelling.

Mild fever, headache, tiredness and nausea may also occur for adolescents and adults receiving Tdap.

However, these are mild, and usually do not interfere with daily activities. Hence, they do not require medical attention.

Other severe reactions such as extensive swelling of the arm where the injection was given is rare.

If any unusual conditions do occur, such as high fever above 38.9°C, difficulty in breathing, wheezing or dizziness, seek the attention of a doctor immediately.

Pertussis is one of the easiest diseases to prevent. Take charge today, and get yourself and your family vaccinated against this disease. Don't ignore adult booster shots using Tdap to protect yourself, your family and society.

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