Whooping cough

Question 1

What is whooping cough (pertussis)?

Answer 1

Severe URTI characterised by severe bouts of spasmodic coughing, which may lead to apnoea in infants following by characteristic gasping for breath

Question 1

What is whooping cough (pertussis)?

Answer 1

Severe URTI characterised by severe bouts of spasmodic coughing, which may lead to apnoea in infants following by characteristic gasping for breath

Question 2

What causes whooping cough?

Answer 2

Gram negative bacterium Bordetella pertussis

*recent resurgence due to lower vaccination uptake

Question 3

What are the presentation of whooping cough?

Answer 3

2-3 days of coryza precede onset of:

=> coughing bouts: usually worse at night and after feeding,

=> Post-tussive vomiting, associated central cyanosis

=> inspiratory whoop: not always present (caused by forced inspiration against a closed glottis)

=> spells of apnoea

=> persistent coughing may cause subconjunctival haemorrhages or even anoxia leading to syncope & seizures

=> symptoms may last 10-14 weeks* and tend to be more severe in infants

=> marked lymphocytosis

=> decreased food intake

Question 4

What is the diagnostic criteria for whooping cough?

Answer 4

Whooping cough should be suspected if a person has:

Acute cough lasting for >14 days without another cause, and has one or more of the following features:
=> Paroxysmal cough.

=> Inspiratory whoop.

=> Post-tussive vomiting.

=> Undiagnosed apnoeic attacks in young infants.

Question 5

How is whooping cough diagnosed?

Answer 5

=> Per nasal swab culture for Bordetella pertussis - may take several days or weeks to come back

=> PCR and serology now increasingly used (easily available)

Question 6

How is whooping cough managed?

Answer 6

=> Infants >6 months with suspect pertussis should be admitted

=> 1st line treatment in children over 1 month of age is with oral macrolide i.e. azithromycin

=> 2nd line treatment in children over 1 month of age is with trimethoprim/sulfamethoxazole

=> household contact offered antibiotic prophylaxis

=> School exclusion: 48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics)

*in the UK pertussis is a notifiable disease

Question 7

What are the complications of whooping cough?

Answer 7

1. Apnoea is a rare but life-threatening acute complication of pertussis
2. Pneumonia either due to bordetella pertusssis or secondary to another organism
3. Seizure triggered by cerebral hypoxia which can develop during severe cough paroxysms
4. Otitis media is the most common complication in pertussis and is often seen in the following few weeks
5. Subconjunctival haemorrhage
6. Bronchiectasis

Question 8

Whooping cough immunisation:

Infants routinely immunised at 2, 3, 4 months and 3-5 years.

Newborn infants are vulnerable, which is why the vaccination campaign for pregnant women was introduced

Answer 8

Neither infection nor immunisation results in lifelong protection - hence adolescents and adults may develop whooping cough despite having had their routine immunisations

Question 9

Vaccination of pregnant women:

In 2012 there was an outbreak of whooping cough (pertussis) which resulted in the death of 14 newborn children.

As a temporary measure, a vaccination programme was introduced in 2012 for pregnant women. This has successfully reduced the number of cases of whooping cough (the vaccine is thought to be more than 90% effective in preventing newborns developing whooping cough).

It was however decided in 2014 to extend the whooping cough vaccination programme for pregnant women. This decision was taken as there was a ‘great deal of uncertainty’ about the timing of future outbreaks.

Answer 9

Women who are between 16-32 weeks pregnant will be offered the vaccine.