OVERVIEW

Ever heard of whooping cough? Well, do not stress if you have not heard of it. However, it is a common medical condition normally mentioned in immunization centers especially used for young children and adolescents. Moreover, it is interesting to note, that is part of the 6 killer diseases of young infants. In view of this, what then is pertussis (whooping cough)?

DEFINITION 

Pertussis is a highly contagious infection caused by a gram-negative bacteria Bordetella pertussis, which normally presents with episodes of coughing which end in prolonged, high-pitched, deeply indrawn breaths called whoops.

This condition normally affects children and adolescents. It is a major concern throughout most developing countries. There is a recent increase in whooping cough because of the loss of immunity in previously vaccinated persons and the refusal of parents to allow their children to be vaccinated.

PATHOLOGY

Just like every respiratory infection, it is transmitted by air droplets of moisture from the infected person, when he or she sneezes, spits, or coughs. Persons who are nearby could inhale these droplets and be infected.

Normally, pertussis is not contagious after the 3rd week of infection.
When the bacteria invade the respiratory tract, it attaches itself to tiny hair-like extensions called cilia in the airways. The bacteria then release toxins (poisons), which damage the cilia and cause the swelling and inflammation of the airway. How then would you know if a person has pertussis?

SIGNS AND SYMPTOMS

Whooping cough normally presents with a 6-week duration, with its symptoms divided into three stages, which are:

A. Stage 1 – Catarrhal Stage:

This stage lasts between 1 to 2 weeks and it includes symptoms such as:
– Runny nose.
– Low-grade fever.
– Mild and occasional cough (Highly contagious).
– Sneezing.
– Tearing.
– Reddening of the conjunctiva of the eye.
– A pause in breathing in babies.

B. Stage 2 – Paroxysmal Stage:

This stage lasts between 1 to 6 weeks and could extend to 10 weeks. It includes symptoms such as:
– Sudden numerous episodes of intense coughing lasting for several minutes, with an occasional loud whoop.
– Vomiting and exhaustion after coughing episodes.

C. Stage 3 – Convalescent Stage:

This stage lasts between 2 to 3 weeks. It presents with increased susceptibility to other respiratory infections. It can last for several weeks. It often presents with these symptoms:
– Gradual recovery.
– Reduced cough but sudden cough episodes normally return.

COMPLICATIONS

Complications normally appear when persons have not received all the recommended vaccines as soon as possible when symptoms of whooping cough persist.

Complications in pertussis infection are categorized according to the groups which mostly affected; children and teenagers (adolescents).

1. Children:

  • Pneumonia (Lung infection).
  • Convulsions (Violent, uncontrolled shaking).
  • Apnea (Slowed or stopped breathing).
  • Encephalopathy (disease of the brain).
  • Death in very severe cases.

2. Teenagers:

  • Pneumonia (Lung infection).
  • Weight loss.
  • Loss of bladder control.
  • Syncope (Fainting or passing out).
  • Rib fractures from severe coughing.
  • Hernia.
  • Coma and death.

EPIDEMIOLOGY

The annual worldwide incidence of whooping cough is estimated to be about 48.5 million cases, with a mortality rate of nearly 295,000 deaths per year. In Africa, nearly 300,000 deaths have been caused by pertussis over the last decade.

In West Africa, due to the lack of systematic and targeted surveillance with laboratory evidence of B. pertussis, it is not definitive to conclude that pertussis is well controlled.

However, based on ongoing demographic surveillance systems capturing morbidity and mortality data, there is currently no significant burden of the disease in young children in West Africa.

DIAGNOSIS

In identifying whooping cough in infected persons, health practitioners normally perform the following:

  • Taking a history of typical signs and symptoms.
  • Physical examination.
  • Laboratory tests which involve taking a sample of mucus (normally with a swab or syringe filled with saline) from the back of the throat through the nose.
  • Blood test.
  • Polymerase chain reaction test on the sample of mucus.

TREATMENT

In managing a person infected with whooping cough and to reduce the risk of infection, your health practitioner would recommend the following:

  • Follow the prescription schedule for antibiotic treatment.
  • Keep your home free of irritants (Smoke, dust, and chemical fumes).
  • Practicing of good hand-washing.
  • Encourage increased fluid intakes such as water, fruit juice, fruits and soups.
  • Encourage intake of small meals every few hours to help prevent vomiting.
    Normally for seriously ill children, they are hospitalized because of their breathing difficulties. They normally require mechanical ventilation through a tube placed in their windpipe. They are also kept in isolation to prevent the risk of infection.

PREVENTION

Vaccination is normally the appropriate means of prevention of whooping cough.

This is normally given to children under 7 years and it lasts for 5 to 10 years. Booster doses are given to adolescents over 19 years and adults over 65 years. It is also recommended after each pregnancy.

When one is exposed to the bacteria, it is necessary to begin postexposure antibiotics. People given this preventive measure are those at high risk of pertussis.

These include:

  • Infants under 12 months old.
  • Women in the 3rd trimester of pregnancy.
  • People with close contact with infants under 12 months, pregnant women or people with severe illness or complications of the disease.
  • People working in child care centers, maternity wards and neonatal intensive care units.

VACCINATION

KEGEL EXERCISE