Whooping Cough (Pertussis)

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Whooping Cough
Overview

What Is The Whooping Cough (Pertussis)?

Pertussis is an acute respiratory infectious disease caused by Bordetella pertussis. Patients present with paroxysmal spasmodic cough with deep, long, chicken-like echoes, and the course of disease can last for several months, so it is called whooping cough.

Is whooping cough common?

Whooping cough is an infectious disease that occurs every 2 to 5 years in many countries or regions with a high mortality rate.

Pertussis occurs mainly in children under 15 years of age, especially in infants, with a high incidence and can develop serious complications, including slow weight gain, apnea, pneumonia, respiratory failure, seizures and death. In the absence of antimicrobial therapy, the child is infectious for much of the protracted course of the disease. In adolescents and adults, infection with B. pertussis may result in prolonged cough and occasionally serious complications.

However, with the popularity of vaccination, the incidence rate has decreased significantly. However, for countries with large population bases, the number of cases is still quite high.

What is pertussis recurrence?

Since the 1990s, in developed countries with high vaccine coverage, there has been a rebound in disease incidence after the disease incidence was controlled to a low level, which some scholars call whooping cough recurrence.

In the past five years, the incidence of whooping cough in many countries or regions began to rise. The reason for the increased incidence is not entirely clear and may be related to the use of experimental techniques such as PCR and serum PT–IgG antibody tests to confirm the diagnosis. A large number of reports have shown that the immune effect of cell-free pertussis vaccine plays an important role in the decline.

Cause

What Is The Cause Of Whooping Cough?

  • What is the cause of whooping cough?

The cause of whooping cough is infection with Bordetella pertussis.

  • Is whooping cough an infectious disease?

Yes, pertussis is a legal class b infectious disease in many countries.

  • How does whooping cough spread?

The incubation period for Bordetella pertussis is 1 to 3 weeks, but most often 7 to 10 days, and all individuals infected with pertussis are infectious until completion of antibiotic therapy. It is mainly transmitted through respiratory droplets and can be transmitted through face-to-face talking, coughing and sneezing.

  • Why do you still get whooping cough after vaccination?

On the one hand, the success rate of vaccination is not 100%. On the other hand, because each person's immune state is different, the titer produced after vaccination is different. If the titer is low, it may be infected. However, after the vaccination, even if the disease, the symptoms are relatively mild.

  • Do adults get whooping cough?

It will. It is mainly found in unvaccinated and low-antibody adults. Many countries have included the whole-cell DPT combined vaccine in the planned immunization. Adults may not have received the vaccine before the implementation of the plan. Even the vaccinated people, the protective antibodies have declined.

Symptom

What Are The Symptoms Of Whooping Cough?

What are the symptoms and manifestations of whooping cough?

Typical manifestations of whooping cough include paroxysmal cough, wheezing and post-cough vomiting. Typical findings are usually seen in unvaccinated children under 10 years of age with primary infection, but can also be seen in vaccinated children and adults.

The course of a typical whooping cough can be divided into three stages:

  • Catarrhal Period

Clinical manifestations are similar to those of viral upper respiratory infections, with mild cough and catarrhal symptoms (runny nose, sneezing, nasal obstruction), and infrequent fever (usually low grade). Unlike viral upper respiratory infections, cough from pertussis gradually aggravates rather than lessens, and catarrhal symptoms persist as watery nasal discharge. Catarrhal period generally lasts for 1–2 weeks.

  • Spasmodic Cough Stage

The severity of cough episodes increases. Characteristic paroxysmal cough: a long series of coughs with little or no inhalation, during which parents often suspect the baby will cough to suppress the past; The cough end is accompanied by a deep and long inhalation, which gives out a special, high-pitched cock-like inspiratory echo, like the cry of a crane, so it is also called crane cough.

This is repeated to produce a thick sputum. Children may experience post-cough vomiting or cough after breastfeeding, facial and vermilion stains, and dyspnea. In the interval between episodes, most children have no obvious symptoms and may have episodes of sweating. Paroxysmal cough can occur spontaneously or be induced by external stimuli and is more pronounced at night. Complications most often occur during this period.

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Spasm cough period may last 2 ~ 8 weeks. The frequency of cough episodes increased gradually during the first 1 to 2 weeks and then remained unchanged for 2 to 3 weeks and then gradually decreased. It can also last for more than two months.

  • Recovery Period

The frequency and severity of the cough gradually diminished, as did post-cough vomiting, which resolved over a period of weeks to months.

What are the atypical manifestations of whooping cough?

Atypical presentations of whooping cough can occur in small infants and in the vaccinated population. Children who are not vaccinated may also have atypical presentations. Atypical presentation varies by age and time to last vaccination.

  • Infants: Clinical manifestations of whooping cough in neonates, especially those younger than 4 months of age, may include:
  1. Catarrhal phase was transient or absent, and the infant in catarrhal phase appeared to be well without fever, with watery catarrhal symptoms, sneezing, and a slight cough.
  2. Spasmodic cough periods are characterized by nausea, wheezing, convex eyes, vomiting, cyanosis, and bradycardia (or tachycardia if severe) and may or may not be paroxysmal.
  3. Complications are numerous and serious.
  • Vaccinated children: clinical manifestations of pertussis infection are usually less severe and have a shorter course.
  • School age children and adolescents: may be asymptomatic or have a mild cough without any characteristic features (ie, no paroxysmal cough, wheezing, post-cough vomiting). Some with wheezing.

Will whooping cough cough be very severe?

Cough due to whooping cough can be very severe, but only a very small percentage of children develop respiratory arrest and suffocation that require rescue.

When is the peak period of whooping cough?

Generally, the cough is most severe in the first to second weeks after the paroxysmal cough occurs.

Is whooping cough dangerous?

Whooping cough can cause death, especially in small babies. Pertussis can also be associated with encephalopathy, and the outcome in these children is poor.

Does whooping cough really last for 100 days?

Whooping cough in young babies usually lasts for three to four months (about 100 days) or longer. Older children spend less time, but at least about a month.

Why children with pertussis are reluctant to eat?

Because eating often leads to cough episodes, children are afraid to eat after multiple stimuli, and they do not want to eat.

Will whooping cough recur?

It will. Some children with pertussis cough decreases or even disappears after treatment and symptomatic treatment. If upper respiratory tract infection is combined during the recovery period, the child may have another paroxysmal cough or aggravation of the original paroxysmal cough.

What are the complications of whooping cough?

The most common complications of pertussis infection include apnea, pneumonia, and weight loss (secondary to feeding difficulties and post-cough vomiting).

Other complications included seizures, encephalopathy, death, sleep difficulty, pneumothorax, epistaxis, subconjunctival hemorrhage, subdural hematoma, rectal prolapse, urinary incontinence, and rib fracture.

Fever during whooping cough is rare or transient, and the presence of marked fever is often associated with other pathogenic infections.

Detect

How To Check For Whooping Cough?

Under what circumstances should a high degree of suspicion of whooping cough be required?

For children who cough for a long time, especially for those who cough for more than 2 weeks, the cough manifests as spasmodic and severe cough with inspiratory crow-like echo and post-cough vomiting. Therefore, the possibility of whooping cough should be highly suspected, and timely medical treatment should be sought.

How should whooping cough be diagnosed?

Pertussis can be diagnosed by asking questions about the history, observing the child's symptoms, performing a physical examination, and some routine blood tests.

The diagnosis can be confirmed by methods such as culture of Bordetella pertussis, detection of antibodies against pertussis, and PCR for pertussis, which require blood or throat secretions.

What is the clinical diagnostic criteria of pertussis in children?

  • 0–3 months old: cough without heat or low grade fever with progressive increase in frequency and severity, plus one of crow-like echo, apnea or post-cough vomiting, cyanosis, convulsions, pneumonia, and close contact with patients (mostly family members) who have had a cough without heat for a long time; Cough may not occur and manifests as paroxysmal apnea, cyanosis, and convulsions.
  • 4 months to 9 years old: no heat, low grade fever, paroxysmal cough ≥ 7 days, non-purulent rhinitis and accompanied by one of the following symptoms: crowing echo, vomiting after cough, apnea, convulsion, pneumonia, aggravation of symptoms at night, and close contact with patients (mostly family members) who had no hot cough for a long time.
  • ≥ 10 years old: paroxysmal dry cough ≥ 2 weeks, non-purulent rhinitis, no heat and accompanied by one of the following symptoms: crow-like echo, apnea, paroxysmal hyperhidrosis at the interval of attack, and night-time aggravation of vomiting after cough.
Prevention

How To Prevent Whooping Cough?

The following precautions against whooping cough:

  • Get the dpt vaccine.
  • Do not expose children to pertussis patients.
  • Prophylactic medication is administered to all persons in the family and in close contact with a confirmed case of pertussis, as well as to any high-risk population exposed to a case of pertussis. Even if these people have been fully vaccinated against whooping cough.
  • Schools and nurseries should comply with the provisions of isolation.
  • The initial vaccination was at 3, 4 and 5 months after birth.
Treatment

How To Treat Whooping Cough?

Here are the treatments for whooping cough:

  • Antibacterial treatment: Macrolide antibiotics such as erythromycin and azithromycin are preferred, and the majority require only one course of treatment.
  • Liquid and Nutrition: Children should be closely monitored for liquid and nutritional status whether they are hospitalized or in home care. Nasogastric tube and intravenous nutrition if necessary.
  • Treatment of cough: The most troublesome thing in the pertussis spasm and cough stage is the frequent and severe cough. At present, there is no particularly effective intervention measure, so symptomatic treatment with drugs remains to be discussed.
  • Keep respiratory tract unobstructed: keep indoor air circulation and the environment quiet and comfortable, avoid stimulating and inducing spasm cough of children, such as excitement, violent activity, low temperature, sputum and nasal discharge. Because asphyxia is rarely encountered, routine use of phlegm and sputum aspiration is generally not required.
  • Active treatment of complications: for patients with combined cardiac and cerebral dysfunction, the corresponding treatment was given.

How long does whooping cough need to be isolated?

  • All individuals infected with whooping cough are infectious until completion of the antibiotic treatment. The respiratory tract was isolated until 5 days after effective antibiotic treatment. In the absence of antibiotic therapy, the respiratory tract was isolated until 21 days after onset.

Does whooping cough need hospitalization?

  • According to the doctor's evaluation, children with severe symptoms need to be hospitalized. Generally, they stay in hospital for about 2 weeks, and the spastic cough disappears. At least they can be discharged without cyanosis.

What should you do if your child eats very little?

  • If the food intake is small and the basic nutritional needs cannot be maintained, the gastric tube needs to be lowered to meet the nutritional needs through nasal feeding and nursing, and the energy and nutrition can also be supplemented through intravenous infusion in hospital.

Is installing gastric tube harmful to the child?

  • It does no harm to the child except it causes a little discomfort.

Is sputum aspiration harmful to children?

  • Sputum aspiration has no big effect on children. However, some irritation may cause discomfort, and some children may suffer from partial hemorrhage and vomit caused by irritation of pharynx.
Life

What Should Pertussis Patients Pay Attention To In Life?

Many children with whooping cough have severe cough causing vomiting and may be reluctant to eat. Feeding can be a small number of meals.

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