Pertussis is a highly contagious bacterial infection of the lower respiratory tract, of long evolution, due to Bordetella pertussis.
Transmission occurs by inhaling droplets released by infected people (coughing, sneezing).
The majority of cases occur among unvaccinated or incompletely vaccinated. Whooping cough affects all age groups.The clinical expression is usually trivial in adolescents and adults, contributing to ignore the infection, promote circulation of B. pertussis and contamination of infants and young children, in whom the infection is severe.
Clinical signs:
After an incubation period of 7 to 10 days, the disease progresses in three phases:
– Catarrhal phase (1-2 weeks): runny nose and cough. At this stage, the disease is confused with a benign infection of the upper respiratory tract.
– Paroxysmal phase (1-6 weeks):
• Typical shape: persistent cough at least 2 weeks with evocative straights followed by breathing in hard, noisy ( “whoop”) or vomiting.
Fever is absent or moderate, clinical examination is normal between straights but the patient feels increasingly tired.
• Atypical forms:
– For children under 6 months: fifths poorly tolerated with apnea, cyanosis; straights or breathing in sound may be missing.
– Adults: persistent cough, often without other symptoms.
• Complications:
– Major: infants, pulmonary superinfection (the onset of fever is an indicator); impact of fifths on the general state with discomfort Food and vomiting, promote dehydration and malnutrition; rarely, convulsions, encephalitis; sudden death.
– Minor: conjunctival bleeding, petechiae, hernia, rectal prolapse.
– Convalescence phase: symptoms resolve within a few weeks or months.
Course of action and treatment:
Suspected cases:
– Admit systematically children under 3 months and children with a severe form. Children under 3 months should be monitored round the clock due to the risk of apnea.
– For children treated as outpatients, show parents what signs which should lead to re-consult (fever, poor general condition, dehydration, malnutrition, apnea, cyanosis).
– Respiratory isolation (as the patient has not received 5 days of antibiotic):
• Home: avoid contact with non / incompletely immunized infants;
• in community: eviction of suspected cases;
• hospital: single room or group of cases (cohorting).
– Hydration and nutrition: moisturize children <5 years, continue breastfeeding. Advise mothers to feed the child after coughing and vomiting that follow, give small amounts frequently.
Monitor the child’s weight during the illness, consider supplementation, up to several weeks after the disease.
– Anti-biotherapy :
Antibiotic treatment is indicated in the first 3 weeks after onset of cough. Infectiousness is practically zero after 5 days of antibiotic therapy.
– For hospitalized children:
• Installation-reclining position (± 30 °).
• oropharyngeal aspirations if necessary.
Topics contacts:
– Antibiotic prophylaxis (same treatment as appropriate) is recommended for children under 6 months of unvaccinated or incompletely vaccinated against pertussis if they have been in contact with a case.
– No eviction for contacts.
Note: in all cases (suspects and contacts), to update the pertussis vaccination.
If the primary series was discontinued, it should be pursued, not early recovery.
Prevention:
routine vaccination with the combined vaccine containing the pertussis (p. ex. DTC or DTP + Hep B + Hib or DTP + Hep B), from the age of 6 weeks or according to the national calendar.
Neither vaccination nor illness, confers definitive immunity.
Reminders are necessary to boost immunity and reduce the risk of developing the disease and passing it to young children.
