, also known as '''whooping cough''', a highly contagious ,
Illinois , with twenty-four high school students catching the disease. In response, the Cook County Department of Public Health provided vaccine, free of charge, to eligible students.
Pertussis was recognizably described as early as
1578 by Guillaume de Baillou (1538-1616), but earlier reports date back at least to the 12th century.
2 ''B. pertussis'' was isolated in pure culture in
1906 by
Jules Bordet and
Octave Gengou , who also developed the first serology and vaccine. The complete ''B. pertussis''
Genome of 4,086,186 base pairs was sequenced in
2002 .
After a two day incubation period, pertussis in infants and young children is characterized initially by mild respiratory infection symptoms such as
Cough ,
Sneezing , and runny nose (
Catarrh al stage). After one to two weeks, the cough changes character, with paroxysms of coughing followed by an inspiratory "whooping" sound (
Paroxysm al stage). Coughing fits may be followed by
Vomiting due to the sheer violence of the fit. In severe cases, the vomiting induced by coughing fits can lead to
Malnutrition . The fits that do occur on their own can also be triggered by yawning, stretching, laughing, or yelling. Coughing fits gradually diminish over one to two months during the convalescent stage. Other complications of the disease include
Pneumonia ,
Encephalitis ,
Pulmonary Hypertension , and secondary bacterial
Superinfection .
3
Because neither
Vaccination nor infection confers long-term immunity, infection of adolescents and adults is also common
4 Most adults and adolescents who become infected with ''Bordetella pertussis'' have been vaccinated or infected years previously. When there is residual immunity from previous infection or immunization, symptoms may be milder, such as a prolonged cough without the other classic symptoms of pertussis. Nevertheless, infected adults and adolescents can transmit the bacteria to susceptible individuals. Adults and adolescent family members are the major source of transmission of the bacteria to unimmunized or partially immunized infants, who are at greatest risk of severe complications from pertussis.
Adults and adolescents are the primary reservoir for pertussis. Pertussis is spread by contact with airborne discharges from the
Mucous Membrane s of infected people, who are most contagious during the catarrhal stage. Because the symptoms during the catarrhal stage are nonspecific, pertussis is usually not diagnosed until the appearance of the characteristic cough of the paroxysmal stage. Methods used in laboratory diagnosis include
Culturing of nasopharyngeal swabs on Bordet-Gengou medium,
Polymerase Chain Reaction (PCR),
Immunofluorescence (DFA), and
Serological methods. The bacteria can be recovered from the patient only during the first three weeks of illness, rendering culturing and DFA useless after this period, although PCR may have some limited usefulness for an additional three weeks. For most adults and adolescents, who often do not seek medical care until several weeks into their illness, serology is often used to determine whether antibody against
Pertussis Toxin or another component of ''B. pertussis'' is present at high levels in the blood of the patient.
Treatment with an effective
Antibiotic (
Erythromycin or
Azithromycin ) shortens the infectious period but does not generally alter the outcome of the disease; however, when treatment is initiated during the catarrhal stage, symptoms may be less severe. Three
Macrolide s,
Erythromycin ,
Azithromycin and
Clarithromycin are used in the U.S. for treatment of pertussis;
Trimethoprim-sulfamethoxazole is generally used when a macrolide is ineffective or is contraindicated. Close contacts who receive appropriate antibiotics (''chemoprophylaxis'') during the 7–21 day incubation period may be protected from developing symptomatic disease. Close contacts are defined as anyone coming into contact with the respiratory secretions of an infected person in the 21 days before or after the infected person's cough began.
Infection with pertussis induces immunity, but not lasting protective immunity, and a second attack is possible.http://files.dcp2.org/pdf/expressbooks/vaccine.pdf Vaccine-Preventable Diseases (Disease Control Priorities Project)Table 20.1, page 390
©2006 The International Bank for Reconstruction and Development
The World Bank
1818 H Street NW
Washington DC 20433
Telephone: 202-473-1000
Internet: www.worldbank.org
E-mail: feedback@worldbank.org Efforts to develop an inactivated whole-cell pertussis
Vaccine began soon after ''B. pertussis'' was grown in pure culture in 1906. In 1925, the Danish physician
Thorvald Madsen was the first to test a whole-cell pertussis vaccine on a wide scale.<
5 He used the vaccine to control outbreaks in the Faroe Islands in the North Sea. In 1942, the American scientist
Pearl Kendrick combined the whole-cell pertussis vaccine with
Diphtheria and
Tetanus toxoids to generate the first DTP combination vaccine. To minimize the frequent side effects caused by the pertussis component of the vaccine, the Japanese scientist
Yugi Sato developed an acellular pertussis vaccine consisting of filamentous hemagglutinin (FHA) and pertussis toxin (PT), which are secreted by ''B. pertussis'' into the culture medium. Sato's acellular pertussis vaccine was used in Japan beginning in 1981.
6 Later versions of the acellular pertussis vaccine used in other countries consisted of additional defined components of ''B. pertussis'' and were often part of the
DTaP combination vaccine.
Pertussis vaccines are highly effective, strongly recommended, and save many infant lives every year. Though the protection they offer lasts only a few years, they are given so that immunity lasts through childhood, the time of greatest exposure and greatest risk.
7 The
Immunization s are given in combination with
Tetanus and
Diphtheria immunizations, at ages 2, 4, and 6 months, and later at 15–18 months and 4–6 years and 11 years.
The short term effectiveness of the vaccines and the presence of ''B. pertussis'' infection in adults and adolescents who may transmit the bacteria to infants have caused many in the medical field to call for booster immunizations at later ages. Although Canada, France, the U.S. and Germany now have approved booster shots for adolescents, adults, or both, other countries adhere to the tradition of discontinuing pertussis vaccination after the age of seven, from concerns that there are side effects associated with the first available "whole-cell" pertussis immunizations that tended to increase with age. The whole-cell vaccine is still used in poor countries, since it is cheaper than the newer and safer acellular formulation.
As the immunity from infection or vaccination lasts only a few years, the discontinuation of booster vaccination in older persons caused the emergence of a large pool of older persons lacking immunity, followed by an increase of adult-onset pertussis that accelerated beginning in about 2004. Enduring and Painful, Pertussis Leaps Back -- By KATE MURPHY New York Times -- February 22, 2005 This burgeoning outbreak is predicted to increasingly infect adults and adolescents with debilitating cases, but poses even more serious public health dangers to newborns. As adolescent and adult cases surge, newborns are again at risk of exposure to pertussis circulating in adolescents or adults in the community before the infants' vaccinations can be completed.
The decision to resume vaccinating teens and adults reflects in part that the newer acellular vaccine, known as DTaP, has greatly reduced the incidence of adverse effects observed with the earlier "whole-cell" pertussis vaccine. An acellular vaccine preparation for adults and adolescents has been approved in s and
Hypotonic episodes.
Much of the controversy surrounding the DTP vaccine in the 1970s and 1980s related to the question of whether the whole-cell pertussis component caused permanent brain injury in rare cases. Although it was well-established that the pertussis component of the DTP vaccine accounted for most of the minor local and systemic side effects in many vaccinated infants, several published studies failed to show a causal relationship between administration of the DTP vaccine and permanent brain injury. However, criticism of these studies and well-publicized anecdotal reports of DTP-induced permanent disability and death gave rise to anti-DTP movements.
9
By the late 1970s, publicity about adverse reactions and deaths following pertussis vaccination caused the immunization rate to fall in several countries, including Great Britain, Sweden, and Japan. In many cases, a dramatic increase in the incidence of pertussis followed.
10 These developments led Yugi Sato to introduce a safer acellular version of the pertussis vaccine for Japan in 1981. Nevertheless, other countries continued to use the whole-cell DTP formulation.
In the United States, low profit margins and an increase in vaccine-related lawsuits led many manufacturers to stop producing the DTP vaccine by the early 1980s. In 1982, the television documentary "DTP: Vaccine Roulette" depicted the lives of children whose severe disabilities were blamed on the DTP vaccine. The negative publicity generated by the documentary led to a tremendous increase in the number of lawsuits filed against vaccine manufacturers.
11 By 1985, manufacturers of vaccines had difficulty obtaining liability insurance. The price of the DTP vaccine skyrocketed, leading to shortages around the country. Only one manufacturer of the DPT vaccine remained in the U.S. by the end of 1985. To avert a vaccine crisis, Congress in 1986 passed the and distributed to developing nations because of its much reduced cost compared to the acellular
DTaP vaccine.
