Pertussis (Whooping Cough) Epidemiology, Prevention and Treatment

PertussisPertussis
(Whooping Cough)(Whooping Cough)
Dr. Harivansh Chopra,Dr. Harivansh Chopra,
DCH, MDDCH, MD
Professor,Professor,
Department of Community Medicine,Department of Community Medicine,
LLRM Medical College,LLRM Medical College,
Meerut.Meerut.
harichop@gmail.comharichop@gmail.com

ObjectivesObjectives
1.1. To study the epidemiology of Pertussis.To study the epidemiology of Pertussis.
2.2. To study prevention and treatment ofTo study prevention and treatment of
Pertussis.Pertussis.
10/24/1610/24/16 22DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
(www.observerzparadise.com)(www.observerzparadise.com)

PertussisPertussis
1.1. Syadenham firstSyadenham first
used the termused the term
“Pertussis”“Pertussis” (intense(intense
cough) in1960.cough) in1960.
2.2. It is preferable to theIt is preferable to the
termterm “whooping“whooping
cough”cough” since mostsince most
infected individualsinfected individuals
do not whoop.do not whoop.

EPIDEMIOLOGYEPIDEMIOLOGY
1.1. Worldwide distribution.Worldwide distribution.
2.2. 16 Million cases in16 Million cases in
2008.2008.
95% in developing95% in developing
countries.countries.
195,000 deaths in195,000 deaths in
childrenchildren

1.29 LAC cases in1.29 LAC cases in
2010 GLOBALLY2010 GLOBALLY
2 DPT 3 IMMUNIZATION2 DPT 3 IMMUNIZATION
RATE WAS 85%RATE WAS 85%
WHOWHO10/24/1610/24/16 55DR HARIVANSH CHOPRADR HARIVANSH CHOPRA

3.3. Pertussis is endemic with epidemicPertussis is endemic with epidemic
cycles every 2 – 3 years aftercycles every 2 – 3 years after
accumulation of susceptible cohorts.accumulation of susceptible cohorts.

India – Decline of PertussisIndia – Decline of Pertussis
83.7%

10/24/1610/24/16 DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
88

99
163000
26700
55070

4.4. Majority of casesMajority of cases
occur from Julyoccur from July
through October.through October.

5.5. Extremely contagious,Extremely contagious,
with attack rate as highwith attack rate as high
as 100% in susceptibleas 100% in susceptible
individuals exposed toindividuals exposed to
aerosol droplets ataerosol droplets at
close range.close range.

6.6. Sub clinicalSub clinical
infection is 50% ininfection is 50% in
fully immunizedfully immunized
and naturallyand naturally
immune individual.immune individual.

Agent FactorAgent Factor
1.1. Agent isAgent is BacillusBacillus
pertussispertussis in majority ofin majority of
cases.cases.
2.2. In 5% casesIn 5% cases BacillusBacillus
parapertussisparapertussis..
3.3. Bacillus pertussisBacillus pertussis doesdoes
not survives for prolongednot survives for prolonged
periods in theperiods in the
environmentenvironment

Source of InfectionSource of Infection
1.1. A case of pertussis, which may be mild,A case of pertussis, which may be mild,
missed or unrecognized.missed or unrecognized.
2.2. Chronic carriage by humans is notChronic carriage by humans is not
documented.documented.10/24/1610/24/16 1414DR HARIVANSH CHOPRADR HARIVANSH CHOPRA

Infective MaterialInfective Material
1.1. Nasopharyngeal andNasopharyngeal and
bronchial secretions –bronchial secretions –
Droplet infection andDroplet infection and
Direct contact.Direct contact.
2.2. Freshly contaminatedFreshly contaminated
fomites.fomites.

Infective PeriodInfective Period
A week afterA week after
exposure to aboutexposure to about
3 weeks after the3 weeks after the
onset of theonset of the
paroxysmal stage.paroxysmal stage.
Secondary Attack rate is 90%.

Incubation PeriodIncubation Period
Ranges from 7 – 14Ranges from 7 – 14
days.days.

Host Factor – AgeHost Factor – Age
1.1. Primarily a disease of infants and pre-Primarily a disease of infants and pre-
school children.school children.
2.2. Higher incidence found below five yearsHigher incidence found below five years
of age.of age.

Host Factor – AgeHost Factor – Age
3.3. Median age of infection :Median age of infection :
1.1. Developing countries – 20-30 months.Developing countries – 20-30 months.
2.2. Developed countries – 50 months.Developed countries – 50 months.
3.3. Infants < 6 months of age have highestInfants < 6 months of age have highest
mortality.mortality.10/24/1610/24/16 1919DR HARIVANSH CHOPRADR HARIVANSH CHOPRA

Female children show higher incidenceFemale children show higher incidence
and mortality.and mortality.
Host Factor – SexHost Factor – Sex

Host Factors - ImmunityHost Factors - Immunity
1.1. Infants are susceptibleInfants are susceptible
to infection from birthto infection from birth
because there is nobecause there is no
protection from maternalprotection from maternal
antibodies.antibodies.
2.2. Recovery from PertussisRecovery from Pertussis
and Adequateand Adequate
Immunisation both leadImmunisation both lead
to immunity.to immunity.

Host Factors - ImmunityHost Factors - Immunity
3.3. Neither natural disease nor vaccinationNeither natural disease nor vaccination
provides complete or lifelong immunityprovides complete or lifelong immunity
against reinfection or disease.against reinfection or disease.
4.4. Protection begins to wane 3 – 5 yrs afterProtection begins to wane 3 – 5 yrs after
vaccination; unmeasurable after 12 yrs.vaccination; unmeasurable after 12 yrs.
5.5. Subclinical reinfection contributesSubclinical reinfection contributes
significantly to immunity against disease,significantly to immunity against disease,
ascribed to vaccine or prior infection.ascribed to vaccine or prior infection.10/24/1610/24/16 2222DR HARIVANSH CHOPRADR HARIVANSH CHOPRA

CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS
Catarrhal Stage
Paroxysmal Stage
Convalescent Stage
Due to long duration of the disease,
Pertussis is also known as “100 day cough”.10/24/1610/24/16 2323DR HARIVANSH CHOPRADR HARIVANSH CHOPRA

Catarrhal StageCatarrhal Stage
1.1. The stage lasts for 7-14The stage lasts for 7-14
days.days.
2.2. It is the most infectiousIt is the most infectious
period.period.
3.3. Features:Features:
1.1. Low-grade fever.Low-grade fever.
2.2. Sneezing.Sneezing.
3.3. Lacrimation.Lacrimation.
4.4. Conjunctival suffusion.Conjunctival suffusion.

Catarrhal StageCatarrhal Stage
4.4. Cough:Cough:
1.1. Not paroxysmal in early stages, but moreNot paroxysmal in early stages, but more
annoying and frequent at night.annoying and frequent at night.
2.2. Does not improve with passage of time,Does not improve with passage of time,
unlike upper respiratory tract infections.unlike upper respiratory tract infections.
3.3. Paroxysmal nature of cough can beParoxysmal nature of cough can be
suspected towards the later part of thissuspected towards the later part of this
phase.phase.10/24/1610/24/16 2525DR HARIVANSH CHOPRADR HARIVANSH CHOPRA

Paroxysmal PhaseParoxysmal Phase
1.1. This stage lasts for 2-4This stage lasts for 2-4
weeksweeks
2.2. Cough:Cough:
1.1. Initially dry, intermittent,Initially dry, intermittent,
irritative hack.irritative hack.
2.2. Evolves into inexorableEvolves into inexorable
paroxysms.paroxysms.

3.3. The bout of cough terminates with alongThe bout of cough terminates with along
drawn out inspiratory crowing sound ordrawn out inspiratory crowing sound or
whoop.whoop.
Cough is a forced expiratory effort
against closed glottis.
Hear cough, click here

WhoopWhoop
The whoop is produced by the air rushingThe whoop is produced by the air rushing
in during inspiration through the half openin during inspiration through the half open
glottis.glottis.
Hear whoop, click here

4.4. The paroxysms of cough may occur everyThe paroxysms of cough may occur every
hour, or even frequently, and mayhour, or even frequently, and may
terminate by vomiting.terminate by vomiting.

5.5. The child may appearThe child may appear
chocked ,is unable tochocked ,is unable to
breath, looks anxiousbreath, looks anxious
and has suffused face.and has suffused face.

6.6. The whoop may not always present inThe whoop may not always present in
infants, who present with apneic orinfants, who present with apneic or
cyanotic spells.cyanotic spells.

Infants <3 mo do not display
classical stages. After the
most insignificant startle from
a draught, light, sound,
sucking, or stretching, a well-
appearing young infant begins
to choke, gasp, and flail
extremities, with face
reddened. Cough (expiratory
grunt) may not be prominent.

Whoop (forceful
inspiratory gasp)
infrequently occurs in
infants <3 mo of age who
are exhausted or lack
muscular strength to
create sudden negative
intrathoracic pressure

A well-appearing, playful toddler
with similarly insignificant
provocation suddenly expresses an
anxious aura and may clutch a parent
or comforting adult before beginning
a machine-gun burst of uninterrupted
coughs, chin and chest held forward,
tongue protruding maximally, eyes
bulging and watering, face purple,
until coughing ceases and a loud
whoop follows as inspired air
traverses the still partially closed
airway.10/24/1610/24/16 3434DR HARIVANSH CHOPRADR HARIVANSH CHOPRA

WhoopWhoop
The whoop is produced by the air rushingThe whoop is produced by the air rushing
in during inspiration through the half openin during inspiration through the half open
glottis.glottis.
Hear whoop, click here

Adults describe a sudden
feeling of strangulation
followed by uninterrupted
coughs, feeling of
suffocation, bursting
headache, diminished
awareness, and then a
gasping breath, usually
without a whoop

Convalescent PhaseConvalescent Phase
1.1. During convalescence, the interval betweenDuring convalescence, the interval between
the paroxysms of cough increases andthe paroxysms of cough increases and
severity of episode decreases gradually.severity of episode decreases gradually.
2.2. Paradoxically, in infants, coughs andParadoxically, in infants, coughs and
whoop may become louder and morewhoop may become louder and more
classic in convalescence.classic in convalescence.

Clinical Manifestations –Clinical Manifestations –
Additional notesAdditional notes
1.1. Immunized childrenImmunized children
have foreshortening ofhave foreshortening of
all stages of pertussis.all stages of pertussis.
2.2. Adults have no distinctAdults have no distinct
stages.stages.

Case definitionCase definition
A suspected case of pertussis is defined as:A suspected case of pertussis is defined as:
A person with aA person with a cough lasting at least two weekscough lasting at least two weeks with atwith at
least one of the following:least one of the following:
 Paroxysms (i.e. fits) of coughingParoxysms (i.e. fits) of coughing
 Inspiratory whoopingInspiratory whooping
 Post-tussive vomitingPost-tussive vomiting
 Without other apparent causesWithout other apparent causes
OROR
Apnoea (with or without cyanosis)Apnoea (with or without cyanosis) in infants (age <1 year old)in infants (age <1 year old)
with cough ofwith cough of any durationany duration
OROR
If aIf a specialist physician strongly suspectsspecialist physician strongly suspects pertussis in a patientpertussis in a patient
with cough ofwith cough of any durationany duration..

3.3. In infants < 3months the catarrhal stageIn infants < 3months the catarrhal stage
is usually a few days or not recognizedis usually a few days or not recognized
at all when apnea chocking or gaspingat all when apnea chocking or gasping
cough herald the onset of disease.cough herald the onset of disease.
Clinical Manifestations –Clinical Manifestations –
Additional notesAdditional notes

MCQsMCQs
1. Which of the following is not true
about Pertussis –
1. The other name is “Whooping cough”.
2. The other name is “Hundred day cough”.
3. Everyone suffering from it must have whoop.
4. It is endemic with superimposed epidemic
cycles every 2-3 years.
Ans. – 3.

Diagnosis – ClinicalDiagnosis – Clinical
1.1. High suspicion index inHigh suspicion index in
individual having pure orindividual having pure or
predominant complaint ofpredominant complaint of
cough f/b vomitting, andcough f/b vomitting, and
Absent:
1. Fever.
2. Malaise / Myalgia.
3. Exanthem / Enanthem.
4. Sore throat, Hoarseness.
5. Tachypnoea.
6. Wheezes, Rales.

Diagnosis – ClinicalDiagnosis – Clinical
2.2. In infants < 3 monthsIn infants < 3 months
of age, Apnea orof age, Apnea or
Cyanosis (beforeCyanosis (before
appreciation of cough)appreciation of cough)
is the clue –is the clue –
occasionally cause ofoccasionally cause of
Sudden Infant Death.Sudden Infant Death.

1.1. Leukocytosis – 15,000-Leukocytosis – 15,000-
100,000cells/mm100,000cells/mm33
..
1.1. Absolute lymphocytosis.Absolute lymphocytosis.
2.2. Absolute increase in neutrophilsAbsolute increase in neutrophils
suggests a differential diagnosis orsuggests a differential diagnosis or
secondary bacterial infection.secondary bacterial infection.
Diagnosis – Blood pictureDiagnosis – Blood picture

Laboratory diagnosisLaboratory diagnosis
 Culture of nasopharyngeal secretionsCulture of nasopharyngeal secretions
considered bestconsidered best
 fastidious growth requirement s makes it difficult tofastidious growth requirement s makes it difficult to
isolateisolate
 chances of isolation maximum during catarrhalchances of isolation maximum during catarrhal
phase and declines rapidly after two weeksphase and declines rapidly after two weeks
 small window of opportunity for culture provensmall window of opportunity for culture proven
diagnosisdiagnosis
 PCRPCR
 detects DNA sequence of the bacteriadetects DNA sequence of the bacteria
 sensitivity decreases after 4 weeks of onsetsensitivity decreases after 4 weeks of onset
 SerologySerology
 useful for diagnosis inuseful for diagnosis in convalescent phaseconvalescent phase

Diagnosis – Chest radiographDiagnosis – Chest radiograph
1.1. Only mildly abnormal –Only mildly abnormal –
perihilar infiltrate or edemaperihilar infiltrate or edema
(sometimes butterfly(sometimes butterfly
appearance), and variableappearance), and variable
atelectasis.atelectasis.
2.2. Parenchymal consolidationParenchymal consolidation
suggests secondarysuggests secondary
bacterial infection.bacterial infection.
3.3. Occasional Pneumothorax,Occasional Pneumothorax,
Pneumomediastinum, andPneumomediastinum, and
air in soft tissues.air in soft tissues.
Pertussis pneumonia with
hyperaeration (air trapping)

Diagnosis – Bacteriological testingDiagnosis – Bacteriological testing
1.1. Isolation ofIsolation of Bacillus pertussisBacillus pertussis is the goldis the gold
standard in diagnosis.standard in diagnosis.
2.2. Positive in catarrhal and paroxysmalPositive in catarrhal and paroxysmal
stage.stage.

Diagnosis – SerologyDiagnosis – Serology
1.1. Tests for detection of antibodies in acuteTests for detection of antibodies in acute
and convalescent samples are mostand convalescent samples are most
sensitive tests in immunised individuals.sensitive tests in immunised individuals.
2.2. Antibody to PT raised >2S.D. indicatesAntibody to PT raised >2S.D. indicates
recent infection.recent infection.
3.3. Useful epidemiologically.Useful epidemiologically.10/24/1610/24/16 4848DR HARIVANSH CHOPRADR HARIVANSH CHOPRA

Differential DiagnosisDifferential Diagnosis
1.1. Adenoviral infections –Adenoviral infections –
distinguishable by presencedistinguishable by presence
of fever, sore throat, andof fever, sore throat, and
conjunctivitis.conjunctivitis.
2.2. Mycoplasma –Mycoplasma –
distinguishable by history ofdistinguishable by history of
fever, headache, & systemicfever, headache, & systemic
symptoms; frequent rales onsymptoms; frequent rales on
chest auscultation.chest auscultation.

Differential DiagnosisDifferential Diagnosis
3.3. Afebrile pneumoniaAfebrile pneumonia
((Chlamydia trachomatisChlamydia trachomatis) –) –
distinguishable by staccatodistinguishable by staccato
cough (i.e. breath with everycough (i.e. breath with every
cough), purulent conjunctivitis,cough), purulent conjunctivitis,
tachypnea, rales.tachypnea, rales.
4.4. Afebrile pneumonia (RSV) –Afebrile pneumonia (RSV) –
distinguishable by lowerdistinguishable by lower
respiratory tract signs.respiratory tract signs.10/24/1610/24/16 5050DR HARIVANSH CHOPRADR HARIVANSH CHOPRA

MCQsMCQs
3. Which of the following is diagnostic
of pertusis
1. Leucocytosis with absolute lymphocytosis.
2. Leucocytosis with relative lymphocytosis.
3. Leucocytosis with neutropenia.
4. Leucocytosis with eosinopenia.
Ans. – 1.

ComplicationsComplications
1.1. Apnea.Apnea.
2.2. SecondarySecondary
infections :infections :
a.a. Otitis media.Otitis media.
b.b. Pneumonia.Pneumonia.
3.3. Flaring up of existingFlaring up of existing
TB infection.TB infection.
4.4. Malnutrition.Malnutrition.

Complications –Complications –
PhysicalPhysical sequel of forceful coughingsequel of forceful coughing
1.1. Conjuctival andConjuctival and
Scleral hemorrhage.Scleral hemorrhage.
2.2. Petechiae in upperPetechiae in upper
body.body.

3.3. Epistaxis.Epistaxis.
4.4. Hemorrhage inHemorrhage in
CNS and Retina.CNS and Retina.

5.5. Pneunomothorax.Pneunomothorax.
6.6. Subcutaneous emphysema.Subcutaneous emphysema.
7.7. Umbilical and inguinalUmbilical and inguinal
hernia.hernia.

TreatmentTreatment
1.1. Antibiotics are useful only in the catarrhalAntibiotics are useful only in the catarrhal
stage.stage.
2.2. Once the child goes in paroxysmal stage itOnce the child goes in paroxysmal stage it
is very difficult to abort the attack.is very difficult to abort the attack.

TreatmentTreatment
1.1. Erythromycin 40-50 mg/kg/day in 4 dividedErythromycin 40-50 mg/kg/day in 4 divided
doses X 14days. (Maximum 2 gm / 24doses X 14days. (Maximum 2 gm / 24
hrs.)hrs.)
2.2. Respiratory Isolation forRespiratory Isolation for ≥ 5 days after≥ 5 days after
start of Erythromycin therapy.start of Erythromycin therapy.10/24/1610/24/16 5757DR HARIVANSH CHOPRADR HARIVANSH CHOPRA

Alternative drugsAlternative drugs
1.1. Clarithromycin 15-20 mg/kg/day in 2 divClarithromycin 15-20 mg/kg/day in 2 div
doses X 7 days. (Maximum 1 gm/24 hrs.)doses X 7 days. (Maximum 1 gm/24 hrs.)
2.2. Azithromycin 10 mg/kg/day once daily X 5Azithromycin 10 mg/kg/day once daily X 5
days.days.

Alternative drugsAlternative drugs
3.3. Ampicillin, Rifampicin and CotrimoxazoleAmpicillin, Rifampicin and Cotrimoxazole
are modestly active against pertussis.are modestly active against pertussis.
4.4. The 1The 1stst
and 2and 2ndnd
generation Cephalosporinsgeneration Cephalosporins
are not active against pertussis.are not active against pertussis.

Recommended treatment and post-exposureRecommended treatment and post-exposure
prophylaxis, by age groupprophylaxis, by age group
Age
group
Azithromycin Erythromycin Clarithromycin
Alternate agent:
TMP-SMX
<1 month
Recommended
drug; 10 mg/kg
per day in a
single dose x 5
days
40–50 mg/kg
per day in 4
divided doses x
14 days
Not
recommended.
Contraindicated in
infants <2 months of
age
1–5
months
10 mg/kg per day
in a single dose x
5 days.
As above
15 mg/kg per
day in 2 divided
doses x 7 days.
For infants aged >2
months of age, TMP
8 mg/kg per day;
SMX 40 mg/kg per
day in 2 divided
doses x 14 days.

Age group Azithromycin Erythromycin Clarithromyci
n
Alternate
agent: TMP-
SMX
Children
aged more
than 6
months
10 mg/kg as a
single dose on day
1 (maximum 500
mg); then 5 mg/kg
per day as a
single dose on
days 2–5
(maximum 250
mg/day)
40 mg/kg per
day in 4
divided doses
for 7-14 days
(maximum 1-2
g per day)
Maximum
1g/day
TMP 8 mg/kg
per day; SMX
40 mg/kg per
day in 2
divided doses
x 14 days
Adolescents
and adults
500 mg as a
single dose on day
1 then 250 mg as
a single dose on
days 2–5
2g/day in 4
divided doses
x 14 days
1g/day in 2
divided
doses x 7
days
TMP 320
mg/day, SMX
1600mg/day in
2 divided
doses x 14
RecommendedRecommended treatment and post-exposuretreatment and post-exposure ProphylaxisProphylaxis,,

MCQsMCQs
2. The attack of pertussis can be
aborted with the help of antibiotics
only if the is treated :
1. In catarrhal stage.
2. In paroxysmal stage.
3. In convalescent stage.
4. In all the above stages.
Ans. – 1.

MCQsMCQs
5. The drug of choice for the treatment
of Pertusis & its dose is
1. Erythromycin 40-50 mg/kg/day
2. Cephalexin 50-100 mg/kg/day
3. Cotrimoxazole 5-8 mg/kg/day
4. Tetracyclin 20-40 mg/kg/day
Ans. – 1.

Care of Household and CloseCare of Household and Close
Contacts – ChemoprophylaxisContacts – Chemoprophylaxis
Erythromycin 40-50Erythromycin 40-50
mg/kg/day in 4mg/kg/day in 4
divided doses X 14divided doses X 14
days regardless ofdays regardless of
age, history ofage, history of
immuinisation, andimmuinisation, and
symptoms.symptoms.

Care of Household and CloseCare of Household and Close
Contacts – ImmunisationContacts – Immunisation
Situation for contact < 7 yearsSituation for contact < 7 years RecommendationRecommendation
Not vaccinated against pertussisNot vaccinated against pertussis
InitiateInitiate
vaccinationvaccination
Partially vaccinated againstPartially vaccinated against
pertussispertussis
Complete theComplete the
recommendedrecommended
scheduleschedule
Received 3Received 3rdrd
dose > 6 mths. backdose > 6 mths. back Booster doseBooster dose
Received 4Received 4thth
dosedose ≥ 3 years back≥ 3 years back Booster doseBooster dose

PREVENTIONPREVENTION
V
A
C
C
I
N
E
S
Purified
Acellular
Vaccine
Whole Cell
Vaccine

Whole cell vaccine (DTP)Whole cell vaccine (DTP)
1. Developed in late 1940s.
2. Bacteria killed by heat or
formalin.
3. Controversial because of
local and systemic side
effects:
1. Redness, Pain, Swelling.
2. Fever (30-70%).

Whole cell vaccine (DTP)Whole cell vaccine (DTP)
4. National Childhood Encephalopathy
Study (Britain) :
1. Infantile Spasms.
2. Sudden Infant Death Syndrome (SIDS).
5. Efficacy :
1. Three doses.
2. 80 - 90% effective.

Purified acellular vaccinePurified acellular vaccine
(DTaP)(DTaP)
1. Introduced in 1981 by
Japan.
2. Contains
subcomponents of
bacteria:
1. Filamentous
Hemagglutinin (Fha).
2. Pertussis Toxin (PT).

Purified acellular vaccine (DTaP)Purified acellular vaccine (DTaP)
3. Efficacy
1. Two doses.
2. 70% protection against culture confirmed
infection.
3. 80% protection against severe whopping
cough.

DTP VaccineDTP Vaccine
1. Content (BE ltd.):
1. Diptheria toxoid ≥20Lf to
≤30Lf.
2. Pertussis ≥4 IU.
3. Tetanus toxoid ≥5Lf to
≤25Lf.
2.2. Dose – 0.5 ml.Dose – 0.5 ml.
3.3. Route – DeepRoute – Deep
intramuscular.intramuscular.
4.4. Recommended site –Recommended site –
Antero-lateral part of thigh.Antero-lateral part of thigh.

Vaccination ScheduleVaccination Schedule
1. Immunization Policy :
1. 3 DPT doses during first year of life.
2. EPI recommendation 6, 10, 14 weeks.
2. Booster Policy :
1. 4th DPT vaccine at 12 to 24 months.
2. 5th DPT vaccine used by some countries
(In India, given 3 years after 4th
dose).

Contraindications to vaccinationContraindications to vaccination
1.1. Personal or strong family history ofPersonal or strong family history of
epilepsy, convulsions or similar CNSepilepsy, convulsions or similar CNS
disorders.disorders.
2.2. Any febrile upset until fully recovered.Any febrile upset until fully recovered.
3.3. Reaction to one of the previously givenReaction to one of the previously given
triple vaccines.triple vaccines.

MCQsMCQs
4. What is the correct composition of
DPT vaccine
1. D ≥40Lf; P ≥4 IU; T ≥5Lf to ≤25Lf.
2. D ≥20Lf to ≤30Lf; P ≥10 IU; T ≥5Lf to ≤25Lf.
3. D ≥20Lf to ≤30Lf; P ≥4 IU; T ≥5Lf to ≤25Lf.
4. D ≥20Lf to ≤30Lf; P ≥4 IU; T ≤25Lf.
Ans. – 3.

Diphtheria toxoid; Tetanus
toxoid; Pertussis vaccine;
Diphtheria toxoid 25 Lf,
tetanus toxoid 10 Lf, purified
Bordetella pertussis antigens
(pertussis toxoid 25 mcg,
filamentous haemagglutinin
25 mcg, 69 kDA outer
membrane protein 8 mcg) per
0.5 mL; aluminium
hydroxide (adsorbant),

Dose: 0.5 mL IMI.
Primary course: 3 doses at 2, 4
and 6 months, then 4th dose at
18 months, 5th dose at 4-5 years

2 TYPES OF VACCINES2 TYPES OF VACCINES
1. Tdap
Combination Vaccine for
Diphtheria, Pertussis &
Tetanus
For all ages 11 years or more
For pregnant Women also

7878
COMPOSITION OF BOOSTRIX
A.DIPHTHERIA TOXOID 2.5 Lf
B.TETANUS TOXOID 5Lf
C.PERTACTIN 2.5 mcg
D.FHA 8mcg
E.PT (INACTIVATED) 8 mcg

Vaccination In PregnancyVaccination In Pregnancy
 IAP recommends thatIAP recommends that
pregnant women receive thepregnant women receive the
whooping cough vaccine forwhooping cough vaccine for
adolescents and adultsadolescents and adults
(called Tdap vaccine) during(called Tdap vaccine) during
the third trimester of eachthe third trimester of each
pregnancy.pregnancy.

Why vaccinate in pregnancyWhy vaccinate in pregnancy
only??only??

Few other facts…Few other facts…
 Vaccinate mother in third trimester of pregnancyVaccinate mother in third trimester of pregnancy
 Vaccinate mother each time she is pregnantVaccinate mother each time she is pregnant
 Breast feeding can transfer antibodies to infantBreast feeding can transfer antibodies to infant
 Blood tests wont tell about the antibody titre inBlood tests wont tell about the antibody titre in
bloodblood

ConclusionsConclusions
1.1. Pertussis is a vaccine preventablePertussis is a vaccine preventable
disease caused bydisease caused by Bacillus pertussis.Bacillus pertussis.
2.2. It is characterised by intensive coughIt is characterised by intensive cough
and whoop, and absence of otherand whoop, and absence of other
systemic features.systemic features.
3.3. Highly contagious disease – prophylaxisHighly contagious disease – prophylaxis
of all contacts recommended.of all contacts recommended.

Pertussis (Whooping Cough) Epidemiology, Prevention and Treatment

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