Resource Packages: Whooping Cough (Pertusis)

Historical Overview  

Whooping cough has been known for centuries. In 1578 C. Ballonius wrote about an outbreak of whooping cough which occurred in Paris in the summer of that year. Thomas Willis, who noted that it resisted treatment with the usual remedies, observed the epidemic nature of the disease in1682.  Between 1670 and 1680 Sydenham introduced the name “pertussis”.  Latin: per=(intensive), tussic=(cough). According to Lapin, whooping cough had become epidemic in Europe by 1732 and was carried by British seamen to Jamaica, Peru and Mexico.

For centuries infants and young children who had whooping cough risked serious complications such as pneumonia, otitis media and convulsions with cyanosis and consequent brain damage. Epidemics appeared in waves, and were intensified by overcrowding and poor sanitary conditions.

This disease has been known by various names over the years but currently the terms most commonly used are “whooping cough” and “pertussis”.

Recent Developments

Pertussis is a serious, sometimes fatal, respiratory infection caused by the Gram negative coccobacillus, Bordetella pertussis.  It is a highly infectious disease, capable of being transferred to 70-100% of susceptible household contacts.

Pertussis begins with mild upper respiratory symptoms and can progress to severe paroxysms of cough, often with a characteristic inspiratory whoop, followed by vomiting.  Fever is absent or minimal.  Symptoms wane gradually. In infants younger than 6 months, apnoea is a common manifestation and the whoop can be absent. Similarly, older children and adults can have atypical manifestations, with persistent cough and no whoop.

Patients are most contagious during the catarrhal stage before the onset of paroxysms. Communicability then diminishes rapidly but may persist for as long as 3 weeks.

Erythromycin therapy decreases infectivity and may limit secondary spread.

Neither natural infection nor immunisation results in lifelong immunity.  The effectiveness of immunisation in reducing the incidence and severity of pertussis is beyond doubt.  Mild, usually unrecognised, pertussis infection can occur in previously vaccinated adolescents and adults. 

Mode of transmission - primarily by direct contact with secretions from respiratory mucous membranes of infected persons by the airborne route, probably by droplets. Frequently brought home by an older sibling.

Incubation period - commonly 7 to 10 days, rarely exceeding 14 days.

Communicability - the disease can be classified into three successive stages:

• Catarrhal Stage - is highly infectious and usually lasts 1 to 3 weeks. This stage begins with minor respiratory symptoms (coryza, sneezing, cough, low-grade fever, and irritability). The cough is initially dry but increases in severity over time and nocturnal involvement becomes prominent
• Paroxysmal Stage - can persist for 6 to 12 weeks. This stage is generally recognised by paroxysm of coughing and characteristic inspiratory whoop. Bouts of coughing followed by choking, vomiting, cyanosis and apnoea can be life threatening. In uncomplicated cases, the baby appears well following recovery from the coughing bout
• Convalescent Stage - dates from the reduction in frequency and severity of coughing bouts and may last from one to several months

Preventative Measures  

Educate the general public, and particularly parents of infants, to the dangers of whooping cough and to the advantages of initiating immunisation and adhering to the immunisation schedule.

At present only whole-cell pertussis vaccine is available in Australia.  Whole-cell pertussis vaccine is a suspension of killed Bordetella pertussis organisms.  The vaccine is usually given in combination with diphtheria and tetanus vaccines (DTP).

Pertussis vaccination is the most effective prophylaxis with studies reporting 85 to 95% protection for children who are fully immunised.  The primary course consists of 3 doses with an interval of 2 months between each dose.  Booster doses are recommended at 18 months and at the time of entry to school 
(4 to 5 years).

Erythromycin prophylaxis should be offered to family contacts and advice sought from the Public Health Units if further information is required.

Standard and Droplet Precautions should be practiced at all times.

Patients (hospitalised) should be nursed in a single room for 5 days after initiation of antibiotic therapy, or until 3 weeks after the onset of paroxysms if appropriate antimicrobial therapy is not given.

Notification to the Public Health Unit - Pertussis is a notifiable disease to the Public Health Unit.   

References

Benenson A.S, ed, 15th ed, 1990.  Control Of Communicable Diseases in Man. American Public Health Association, Washington.

Committee on Infectious Diseases, American Academy of Pediatrics, 23rd ed.1994. Red Book, Report  of the Committee on Infectious Diseases, America.

National Health and Medical Research Council, 4th ed. 1991.  The Australian Immunisation Procedures Handbook.  Canberra.

National Health and Medical Research Council, 5th ed. 1994.  The Australian Immunisation Procedures Handbook.  Canberra.

NSW Health Department, 1999.  Infection Control Policy. 99/87 AIDS/Infectious Diseases Branch.  Sydney.

Reid D, Grist N R, Pinkerton IW, 1986.  Infections in Current Medical Practice. Butterworth, London.

The British Medical Association Guide,1989.  Infection Control.  Hodder and Stoughton, London.

The Children’s Hospital, Camperdown, 1993. Nursing Care of a Child With Pertussis.  Clinical Cross Infection Committee.  Sydney.

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