1. PERTUSSIS “WHOOPING COUGH” Dr Ubaid N P JR Community MedicinePariyaram Medical College

2. ▪ Acute infectious disease caused by Bordetella pertussis ▪ Hundred day cough ▪ Important cause of death in infants ▪ Insidious onset, mild fever, irritating cough whoop(loud crowing inspiration)

3. EPIDEMIOLOGICAL DETERMINANTS ▪ AGENT – Causative agent is B.pertussis – <5% - B.parapertussis – Encapsulated, phase 1 strains – Carries 3 major agglutinogens 1 2&3 – Survive only short period outside human body SOURCE OF INFECTION B.Pertussis infects only man Source is a case of pertussis No c/c carrier state

4. ▪ INFECTIVE MATERIAL Nasopharyngeal and bronchial secretion ▪ INFECTIVE PERIOD Most infective during catarrhal stage. One week after exposure to 3 weeks after onset of paroxysmal stage ▪ SECONDARY ATTACK RATE Averages 90% in unimmunized household contacts

5. HOST FACTORS ▪ AGE Primarily disease of infants and preschool children  SEX Incidence and fatality more among females  IMMUNITY Recovery from whooping cough & immunization  ENVIORNMENTAL FACTORS occur through out year more in winter and spring Low socioeconomic group

6. ▪ MODE OF TRANSMISSION Droplet infection and direct contact ▪ INCUBATION PERIOD 7 to 14 days ▪ CLINICAL COURSE It produces local infection Organism not invasive Multiplies on epithelium of resp tract Cause inflammation necrosis of mucosa

7. (a)Catarrhal stage lasting for 10 days. Insidious onset lacrimation,sneezing coryza, malaise, hacking night cough (b)Paroxysmal stage 2-4 weeks Characterized by burst of rapid consecutive cough followed by deep high pitched inspiration[whoop],vomiting In infants, cyanosis apnoea (c)Convalescent stage Lasting for 1-2 weeks 3 stages of clinical course

8. COMPLICATIONS: ▪ Bronchitis,bronchopneumonia,bronchectasis, ▪ Subconjunctival haemorrhage ▪ Haemoptysis ▪ Epistaxis, ▪ Punctate cerebral haemorrhage-convulsion and coma ▪ Pertussis- associated encephalopathy

9. CONTROL OF WHOOPING COUGH ▪ CASES AND CONTACTS Early dx by bacteriological exmn of secretions Fluorescent antibody technique Erythromycin is doc 30-50 mg/kg bwt 4 divided doses for 10 days ▪ CONTACTS Prophylactic erythromycin or ampicillin for 10 days

10. ▪ Active immunisation DPT 3 DOSES 0.5 ML 6,10 14 WEEKS BOOSTER 18-24 mnths UNTOWARD REACTION Local reacns: at injection site,mild fever,irritability Rare reacns:inconsolable screaming, seizures,hypotonic hyporesponsive episodes,anaphylactic reaction,encephalopathy.

11. ▪ CONTRAINDICATIONS Anaphylaxis,encephalopathy,epilepsy,febrile episodes, reaction to previous vaccination

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