Whooping cough is an infectious disease caused by the Bordetella pertussis bacterium. It is characterized by severe coughing fits that end in a "whooping" sound. It mainly affects young children and can be serious, even life-threatening, especially in infants. Vaccination is the most effective way to prevent whooping cough through active immunization with the DPT vaccine according to national immunization schedules.

1. PERTUSIS
(WHOOPING COUGH)

2.  Acute infectious disease of young children,
caused by Bordetella pertusis.
 Characterized by an insidious onset with mild
fever and irritating cough, gradually becoming
paroxysmal with the characteristic “whoop” (loud
crowing inspiration) often with cyanosis and
vomiting.
 The Chinese call it a “Hundred Day Cough”.

3. PROPLEM STATEMENT
 Important cause of deaths in infants worldwide
 Public health concern even in countries with high
vaccination coverage
 During 2012 about 2.49 lac cases were reported
to WHO globally and the DPT3 immunization rate
was 83 percent

4. CONTI..
 In India, marked decline of the disease after
launch of UIP.
 1987 -> 1.63 lac cases reported
 2014 -> 61,417 cases reported
 Showing decline of about 62.3 percent

5. EPIDEMIOLOGICAL DETERMINANTS
Agent factors
a) AGENT : Bordetella pertusis (large proportion of
cases), B. parapertusis (less than 5% cases)
- Occurs in smooth and rough phases, capsulated
and non-capsulated forms, and elaborates an
exotoxin and endotoxin.
-Gram-negative, aerobic, pathogenic, encapsulated
coccobacillus
- Bacterium survives only for very short periods
outside the human body.

6. BORDETELLA PERTUSIS

7. c) SOURCE OF INFECTION : Case of pertusis, infects
only man, chronic carrier state does not exist and
no evidence that infection is subcllinical.
d) INFECTIVE MATERIAL : Nasopharyngeal and
bronchial secretions
e) INFECTIVE PERIOD : Extend from a week after
exposure to about 3 weeks after the onset of the
paroxysmal stage, most infectious during catarrhal
stage.
f) SECONDARY ATTACK RATE : 90% in unimmunized
household contacts

8. HOST FACTORS
a) AGE : Disease of infants and pre-school children,
highest incidence – below the age of 5 years, Infants
below the 6 months have the highest mortality.
b) SEX : Incidence and fatality – more among female
than male children.
c) IMMUNITY : Recovery from whooping cough or
adequate immunization is followed by immunity.
Infants are susceptible to infection from birth
because maternal antibody does not appear to give
them protection.

9. ENVIRONMENTAL FACTORS
 Seasonal trend with more cases occurring during
winter and spring months, due to overcrowding
and indoor living, greater in lower social classes.
MODE OF TANSMISSION
 Droplet infection and direct contact
INCUBATION PERIOD
 7 to 14 days

10. CLINICAL FEATURES
 B. pertusis produces a local infection; the organism
is not invasive.
 It multiplies on the surface epithelium of the
respiratory tract and causes inflammation and
necrosis of the mucosa leading to secondary
bacterial invasion.
 Three stages – in the clinical course of the disease.

11. Conti..
a) CATARRHAL STAGE : Lasting for about 10 days,
characterized by insidious onset, lacrimation,
sneezing and coryza, anorexia and malaise, and a
hacking night cough that becomes diurnal.
b) PAROXYSMAL STAGE : Lasting for 2—4 weeks,
characterized by burst of rapid, consecutive coughs
followed by a deep, high-pitched inspiration
(whoop), followed by vomiting.
c) CONVALESCENT STAGE : Lasting for1-2 weeks.

12. COMPLICATIONS
 Occur in 5-6 % of cases
 Bronchitis, bronchopneumonia and bronchiectasis,
subconjuctival hemorrhages, epistaxis, haemoptysis
and punctate cerebral hemorrhages which may cause
convulsions and coma.
 Incidence of pertusis-associated encephalopathy is
0.9 percent 100,000.
 In developing countries the average mortality is 3.9
percent in infants and 1 percent in children aged 1-4
yeaars.

13. CONTROL OF WHOOPING COUGH
1. CASES AND CONTACTS
a) Cases :
 Early diagnosis, isolation and treatment of cases,
and disinfection of discharges from nose and
throat.
 Early diagnosis by bacteriological examination of
nose and throat secretions by naso-pharyngeal
swabs.
 Erythromycin is the drug of choice, 30-50mg/kg of
body weight in 4 divided doses for 10 days.

14. Conti..
 Antibiotics may prevent or moderate clinical pertusis
when given during incubation period or in early
catarrhal stage.
 During paroxysmal stage, antimicrobial drugs may
eliminate the bacterium from the nasopharynx and
reduce transmission of disease.
 Useful in controlling secondary bacterial infections.

15. b) Contacts :
 Infants and young children should be kept away
from cases.
 Contacts with whooping cough, may be given
prophylactic antibiotic (erythromycin or ampicillin)
treatment for 10 days

16. 2. ACTIVE IMMUNIZATION
 Active immunization is the best preventive measure
for pertusis.
 The vaccine is administered in National
Immunization Schedule as combined Pentavalent
vaccine.
 Pentavalent vaccine provides protection to a child
from 5 life-threatening diseases – Diphtheria,
Pertussis, Tetanus, Hepatitis B and Hib.

17. Conti..
 3 doses of pentavalent (0.5ml), Intramuscularly at
the age of 6,10 and 14 weeks.
 Booster 1st at 16-24 months and 2nd booster at 5-6
years of age, as combined DPT vaccine in NIS.
 Efficacy – 46% to 92% (avg. 85%)

18. ACELLULAR PERTUSIS VACCINE
 Used for vaccination of older children and adults
 Lesser side effects
 Available preparation – aP, DTap, TdaP
 Efficacy – 54% to 89%
 The duration of protection following the primary 3
dose course in infants and 1 booster dose (1 year
later)- Average 6-12 years for both whole cell and
acellular pertusis vaccine.

19. UNTOWARD REACTIONS
 Local reactions at the site of injections
 Mild fever and irritability
 Rare vaccine reactions are persistent (more than 3
hours) inconsable screaming, seizures, hypotonic
hypo-responsive episodes, anaphylactic reactions
and very rarely encephalopathy.

20. CONTRAINDICATIONS
 Anaphylactic reactions
 Encephalopathy
 Personal or strong family history of epilapsy
 Convulsions
 CNS disorders
 Reaction to one of the previously given pentavalent
or triple vaccine injections.

21. 3. PASSIVE IMMUUNIZATION
 No evidence of its efficacy in well-controlled trials.
CONCLUSION
 Whooping cough is a disease of respiratory mucous
membrane.
 It is a bacterial and contagious disease which mainly
caused by Bordetella Pertusis.
 It mainly occur in young children (3-5 years).
 It can be prevented by active immunization.
 It is treated by DPT vaccine and antibiotics.