Pertussis (whooping cough)

• Published in: BMJ (Online) 2019-02, Vol.364, p.l401-l401
• Main Authors: Gopal, Dipesh P, Barber, John, Toeg, Daniel
• Format: Article
• Language: English
• Subjects: Age; Antibiotics; Babies; Cough; Disease prevention; Fever; Gestation; Immunity (passive); Immunoglobulin G; Infants; Infections; Maternal & child health; Neonates; Patients; Pertussis; Pregnancy; Respiration; Respiratory tract diseases; Vaccine efficacy; Vaccines; Vomiting; Whooping cough; Womens health
• ISSN: 0959-8138; 1756-1833
• DOI: 10.1136/bmj.l401

What you need to know Suspect pertussis in patients with 2 weeks of cough and coughing paroxysms, post-tussive vomiting, inspiratory whooping, no fever, or exposure to a person with confirmed pertussis Immunisation is no guarantee of protection as vaccine efficacy decreases with time Antibiotics within the first 21 days of illness can prevent transmission, but cough is likely to last up to three months and there are no recommended treatments for it Consider admission if patient is clinically unwell or less than 6 months old, when mortality is higher Report suspected and confirmed cases of pertussis to local public health agencies to initiate infection control measures Offer pertussis vaccination to pregnant women in the second or third trimesters of pregnancy as it can provide passive immunity to neonates and young infants Pertussis, also known as whooping cough, is caused by the Gram negative bacterium Bordetella pertussis.1 It is transmitted via airborne droplets and is highly infectious.2 Diagnosis is often delayed or missed,3 as pertussis mimics the presentation of a viral upper respiratory tract infection and can sometimes present atypically.2 In this article, we review the management of pertussis and present recent evidence and guidance on prevention through vaccination. The evidence on relative effectiveness and duration of active immunity of the vaccines is inconsistent.562 A recent meta-analysis found lower short term protective effect with acellular vaccines (vaccine efficacy 84% (95% confidence interval 81 to 87)) compared with whole cell vaccines (94% (88 to 97)) within three years of completion of primary immunisation.63 The effectiveness of acellular pertussis vaccine decreases with time,64 as reported in several case-control studies.6566676869 The short protection provided by vaccination suggests the possibility of repeated infections in both immunised and non-immunised individuals. The need for regular pertussis boosters throughout life must be explored.70 A new genetically inactivated acellular vaccine is being studied in adolescents.71 The World Health Organization recommends that countries using whole cell pertussis vaccine should continue to do so and consider a switch to the acellular vaccine only if additional periodic booster or vaccination in pregnant women can be assured and sustained.5 Vaccination in pregnancy Pertussis vaccination in pregnancy may provide passive immunity to the infant via transplacental transfer of IgG, before p