Pertussis

Pertussis is a serious respiratory infection that can affect people of all ages, but it is particularly dangerous for infants and young children. Characterised by a severe cough that can make it difficult to breathe, pertussis is a vaccine-preventable disease. However, due to waning immunity or incomplete vaccination, outbreaks can still occur. This detailed guide will provide you with a thorough understanding of pertussis, empowering you to protect yourself and your loved ones.

Pertussis, or whooping cough, is a bacterial infection caused by the bacterium Bordetella pertussis. This bacterium attaches to the lining of the airways in the lungs, releasing toxins that damage the cilia (tiny hair-like structures that help clear mucus from the airways). This damage leads to inflammation and narrowing of the airways, causing the characteristic pertussis cough.

Pertussis typically progresses through three stages:

1. Catarrhal stage: This initial stage, lasting 1-2 weeks, is when the bacteria are most actively multiplying. It is also the period when an individual is most contagious.
2. Paroxysmal stage: This stage can last for 2-6 weeks or longer. It is during this stage that the characteristic "whooping" cough develops. The severity and frequency of coughing fits can vary significantly between individuals.
3. Convalescent stage: This recovery phase can last for weeks or months. While the body is recovering and the severity of the cough diminishes, the individual may be more susceptible to other respiratory infections.

Pertussis is a global health concern, affecting millions worldwide. While vaccination has significantly reduced its incidence, outbreaks still occur. In India, there were 4949 cases of pertussis in 2023. Whereas globally, the number crossed over 1.5 lakh cases in the same year. 

Pertussis is highly contagious and spreads easily through:

Airborne droplets

When an infected person coughs or sneezes, tiny droplets containing the bacteria are released into the air and can be inhaled by others. These droplets can travel a significant distance, especially in enclosed spaces.

Close contact

Spending time in close proximity to an infected person, such as within a household, school, or workplace, increases the risk of transmission. Sharing personal items like utensils or towels can also spread the bacteria.

Asymptomatic carriers

Some individuals can carry and spread the bacteria without showing any symptoms themselves, making it difficult to control the spread of the infection.

Pertussis symptoms can vary depending on the stage of the infection and the individual's age and overall health. Common symptoms include:

• Runny nose and congestion: Similar to a common cold, this is often one of the first symptoms to appear.
• Sneezing: Frequent sneezing can occur, especially in the early stages.
• Low-grade fever: A mild fever may be present, but it is not always a prominent symptom.
• Mild cough: Initially, the cough may be mild and dry, gradually worsening over time.
• Intense coughing fits (paroxysms): These fits can be so severe that they can cause vomiting, exhaustion, and difficulty breathing.
• "Whooping" sound: This characteristic sound occurs when the person tries to inhale after a coughing fit.
• Apnea (pauses in breathing): This is a serious complication, particularly in infants, and requires immediate medical attention.
• Other symptoms: Other symptoms can include facial redness or blueness due to lack of oxygen during coughing fits, watery eyes, and a feeling of exhaustion.

Diagnosing pertussis involves a combination of:

Physical examination

A doctor will assess the patient's symptoms, listen to their lungs for characteristic sounds, and check for signs of respiratory distress.

Medical history

The doctor will inquire about the patient's vaccination history, recent travel, and potential exposure to pertussis. This information can help determine the likelihood of infection.

Laboratory tests

• Nasopharyngeal swab: A sample is collected from the back of the nose and throat to test for the presence of Bordetella pertussis bacteria through culture or polymerase chain reaction (PCR) testing. PCR is generally more sensitive and faster than culture.
• Blood tests: May be used to detect antibodies to the bacteria, indicating a recent or past infection. However, these tests are less useful in vaccinated individuals or young infants due to the presence of maternal antibodies.

Pertussis treatment typically includes:

Antibiotics

Antibiotics, such as macrolides (e.g., erythromycin, azithromycin, clarithromycin), are the primary treatment for pertussis. They are used to kill the bacteria and shorten the duration of the illness. Early treatment is crucial to reduce the severity, prevent the spread of infection to others, and reduce the risk of complications.

Supportive care

This includes getting plenty of rest, drinking fluids to prevent dehydration, and using a humidifier to ease breathing. In severe cases, hospitalization may be necessary for oxygen therapy, respiratory support, and intravenous fluids.

Prophylactic antibiotics

In some cases, antibiotics may be given to close contacts of an infected person to prevent them from developing the illness, even if they are vaccinated. This is particularly important for infants and young children who are at high risk of complications.

While no alternative therapies can cure pertussis, some complementary approaches may help manage symptoms and support overall well-being. These include:

• Honey: Honey can help soothe a cough and may have antibacterial properties. (Note: Honey should not be given to children under 1 year old).
• Warm baths: Steam from a warm bath can help loosen mucus and ease breathing difficulties.
• Humidifiers: Adding moisture to the air can help soothe irritated airways.
• Essential oils: Certain essential oils, such as eucalyptus or peppermint, may help relieve congestion and coughing. However, they should be used with caution, especially around children.

Always consult with a healthcare professional before using any alternative therapies, especially for infants and young children.

Certain factors increase the risk of pertussis:

• Infants and young children: Babies under 1 year old are at the highest risk of severe complications, including pneumonia, seizures, and brain damage. This is because their immune systems are still developing, and they may not have received the full course of vaccinations.
• Unvaccinated or under vaccinated individuals: People who have not received the pertussis vaccine or have incomplete vaccination are more susceptible to infection. This includes individuals who have delayed or refused vaccination or those who have waning immunity from previous vaccinations.
• Weakened immune systems: Individuals with weakened immune systems due to conditions like HIV/AIDS, cancer, or certain medications are more vulnerable to infections, including pertussis.
• Exposure to infected individuals: Close contact with someone who has pertussis increases the risk of contracting the illness. This is particularly true in crowded settings like schools, daycare centres, or healthcare facilities.

Pertussis can lead to serious complications, especially in infants and young children. These include:

• Pneumonia: A lung infection that can cause difficulty breathing and chest pain.
• Seizures: Uncontrolled electrical activity in the brain.
• Encephalopathy: Inflammation of the brain that can lead to permanent brain damage.
• Apnoea: Pauses in breathing.
• Death: In severe cases, pertussis can be fatal, particularly in infants.
• Other complications: Other complications of pertussis can include ear infections, sinus infections, weight loss, and hernias.

1. Get plenty of rest to aid recovery.

2. Drink lots of fluids to prevent dehydration.

3. Eat nutritious foods to support your immune system.

4. Use a humidifier to moisten the air and ease coughing.

5. Eat small, frequent meals as it can help prevent vomiting after coughing fits.

6. Identify and avoid things that trigger coughing fits, such as smoke, dust, or strong odours.

7. Adhere to your treatment plan and attend all medical appointments.

Only babies get whooping cough. 

Pertussis can affect people of all ages, although it is most severe in infants.

The pertussis vaccine provides lifelong immunity. 

Immunity from the vaccine wanes over time, making booster shots necessary.

You can't get pertussis twice.

It is possible to get pertussis more than once, even if you have been vaccinated.

Seek medical attention if you or your child experience:

• A severe cough that lasts for more than two weeks.
• Coughing fits followed by a "whoop" sound.
• Difficulty breathing or turning blue during coughing fits.
• Vomiting after coughing.
• Apnea (pauses in breathing).
• Any signs of dehydration or respiratory distress.

• Is it pertussis or another respiratory infection?
• What are the treatment options?
• How long will the cough last?
• Are there any complications to be aware of?
• When can my child return to school or daycare?
• What can I do to prevent spreading the infection to others?

• Provide practical help: Offer assistance with childcare, meal preparation, or errands.
• Encourage rest: Help create a restful environment.
• Offer emotional support: Be patient and understanding.
• Ensure they follow medical advice: Help them adhere to their treatment plan and attend medical appointments.
• Help prevent the spread of infection: Remind them to practice good hygiene and avoid contact with others, especially infants and young children.

Pertussis is a serious but preventable disease. Understanding its causes, symptoms, and prevention strategies is crucial for protecting yourself and your loved ones. Vaccination remains the most effective way to prevent pertussis. If you suspect you or someone you know may have pertussis, seek medical attention promptly.