Whooping Cough: Review

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Table of Contents

Background Information
Risk Factors
Diagnosis and Treatment
Prevention
Conclusion
References

Whooping cough, which is also known as pertussis, is a respiratory disease marked by its high rate of contagiousness. The condition is caused by the Bordetella pertussis bacterium. Whooping cough is practically uncontrollable and features violent coughing fits that make it hard to breathe (Cherry, 2015b). Individuals with pertussis have to take deep breaths after cough fits, which leads to howling sounds. The pertussis condition is rather serious because it can affect individuals of all ages and even lead to demise among babies (Cherry, 2015b). The current paper aims to review the key concepts about whooping cough and outline the potential diagnosis, treatment, and prevention options.

Background Information

Whooping cough is a dangerous condition that affects a person to a point where the latter could be exposed to coughing fits that last for up to 10 weeks. As one of the essential contributors to serious illnesses in people of all ages, pertussis is considered to be one of the most dangerous (even life-threatening) conditions that affect babies (Aslanabadi et al., 2015). The current statistics show that at least 50% of all babies with pertussis require specific hospital-based treatment. The DTaP vaccine became one of the most effective methods to prevent pertussis in children and babies, while the TDaP vaccine is utilized for teens and adults. In order to protect babies, pregnant women are also vaccinated with TDaP (Cherry, 2015b). Regardless, vaccinated people may also spread pertussis and become infected. The difference is that the condition is much less adverse in the case where an individual has been vaccinated previously. One of the general treatments available to clinicians are antibiotics (Terry et al., 2015). The latter is utilized to slow down the spread of the disease and control the essential symptoms of pertussis.

Whooping cough is an important condition because there are at least 24 million cases that affect people of all ages worldwide. A staggering number of deaths per annum (approximately 160,000) also makes pertussis a condition worth medical and communal attention (Cherry, 2015b). During the peak of pertussis in the United States in 2012, there were approximately 50,000 of whooping cough cases reported, but it may be safe to say that there is a similar number of cases that went unreported and undiagnosed (Cherry, 2015b). Taking into consideration the last five decades of pertussis cases reported across the United States, it may be concluded that the number of patients with whooping cough continues to increase for unknown reasons. This trend is most damaging among the patients aged from seven to 10 years old, with the other groups remaining affected by a drastic increase in the number of pertussis infections as well.

Risk Factors

Even though whooping cough may affect individuals of any age, the high-risk populations include several categories of potential patients:

People who did not take a whooping cough booster within the last 10 years;
People who live together with a person that has whooping cough;
Babies younger than six months that cannot be fully vaccinated due to their age (Duncan, 2018).

The highest level of risk may be attributed to babies because they are most likely to go to the hospital or even pass away because of whooping cough. The current statistics show that at least one baby out of 200 die owing to whooping cough, which results in either brain damage or pneumonia (Green et al., 2017). The problem with whooping cough is that adults or older children also are exposed to the disease, even if to its milder version.

The vaccine eventually diminishes in the majority of people who received it as a child. This is why it is important to take immediate action in the case of an outbreak. Pertussis infection spreads rather quickly and turns children and teenagers into one of the most susceptible populations (Green et al., 2017). With regular outbreaks, the younger groups of people will have fewer chances to survive if they are not vaccinated or have no access to every recommended vaccine. Whooping cough is relatively often associated with severe complications and demise, so it is critical to make sure that all necessary infant vaccines are in place.

Additional evidence on the topic also proves that extended contact with children aged between 10 and 14 who have a whooping cough is one of the most significant risks for the development of pertussis in adults. The most likely sources of infection in the case of adult pertussis are work colleagues and that person’s children (Green et al., 2017). The problem with children aged from 10 to 14 is that their immunity wanes, and they become much more susceptible to different conditions that affect resistance to illnesses and also maximize the potential of household transmission of whooping cough. It may be claimed that children with aP booster vaccines have weaker immunity than children vaccinated with wP vaccines exclusively (Dorji et al., 2018). Even though the roots of this issue have not been investigated in rich detail, the idea could be that pertussis outbreaks affect children with weaker immunity and cause other household members to experience whooping cough.

Diagnosis and Treatment

The process of diagnosing pertussis may be challenging due to the fact that it is rather similar to a cold or any other common respiratory illness. There may be cases where doctors may be able to diagnose pertussis by simply listening to the cough, but the literature suggests that the diagnosis should be confirmed by medical tests in complex situations. There are three most common types of medical tests that are used to diagnose whooping cough. First of all, the doctor could take a suction sample from nasopharynx in order to check if the pertussis bacteria are present in the area where the nose and throat meet (Hayles et al., 2015). Another diagnostic measure that may be used is a blood test. In this case, the doctor would be looking at white blood cells to make sure that the patient’s body will be able to fight infections (including pertussis) (Dorji et al., 2018). The last type of test is a chest x-ray, which is needed to check the patient’s lungs for inflammation or fluid (Garbiras et al., 2016). This step is required to make sure that there are no secondary conditions, such as pneumonia, that could reduce the patient’s chances of fighting pertussis.

As for the process of treatment, infants are often hospitalized immediately due to a large number of complications that might appear in patients from that age group. The person suffering from whooping cough should be isolated in order to prevent the spreading of pertussis. The majority of cases in adults and older children are managed at home (Duncan, 2018). The most appropriate medications for pertussis treatment are antibiotics, as they speed up the recovery process and kill the bacteria that cause whooping cough. Family members that are exposed to pertussis may intake preventive medications to reduce the chances of transmission, but the cough cannot be relieved (Duncan, 2018). Whooping cough cannot be treated with the help of over-the-counter cough medicines, which is why medications other than antibiotics are largely discouraged.

Prevention

As it becomes evident from the literature on the subject, the best way to protect oneself from pertussis is to benefit from timely vaccines. Among clinicians, there is also a common understanding regarding the use of preventive antibiotics that are expected to help people relief the symptoms of whooping cough and avert further development of severe pertussis (Cherry, 2015a). As per the recommendation from CDC, all four groups of patients – adults, adolescents, infants, and children – have to receive pertussis vaccines in order to be fully protected. The youngest children should receive five doses of DTaP (Cherry, 2015a). Children aged 11 or slightly older are recommended to get just one dose of DTaP.

Another population that may benefit from DTaP dosages are pregnant women that may be expected to intake the required medicine from the 27th gestational week through the 36th (Cherry, 2015a). Every adult that has not experienced the TDaP vaccination should be vaccinated at least once every ten years (TD vaccine is also an acceptable option). Another possible way of preventing pertussis may be the postexposure antimicrobial prophylaxis (Cherry, 2015a). The evidence suggests that the use of antibiotics may be acceptable for (a) those individuals who are at most risk of developing severe whooping cough and (b) individuals that will have close contact with persons who are already affected by severe pertussis.

Conclusion

The existence of modeling and empirical evidence suggests that booster vaccination is one of the most effective means of preventing pertussis and reducing the incidence of whooping cough condition among children and adolescents. On the other hand, the current evidence also suggests that the indirect effect on adults and older children have not been adequately addressed yet. This leaves room for the conclusion that vaccinated individuals still represent a threat to unimmunized infants and unvaccinated people of all ages. The lack of a strong immune system directly affects a person’s susceptibility to whooping cough and makes it harder for clinicians to prevent the spread of pertussis across their local areas. The problem may also relate to non-specific symptomatology and the lack of compliance among older individuals.

As may be concluded on the basis of information obtained within the framework of the existing research, the primary reason for collecting more evidence and deploying vaccination programs is to prevent infant disease. Knowing that the spreading of pertussis does not stop when a person is vaccinated, it may be claimed that there are no indirect means of protection available to clinicians who have to treat pertussis in infants. Improved programs aimed at whooping cough could have a positive effect on the population and highlight the need to complete additional research in the area. Public health benefits of reducing the occurrence of whooping cough are practically limitless. Therefore, adolescent and maternal vaccinations should be promoted further, so that infants (as the most vulnerable population) would be protected from the adverse outcomes of whooping cough.

References

Aslanabadi, A., Ghabili, K., Shad, K., Khalili, M., & Sajadi, M. M. (2015). Emergence of whooping cough: Notes from three early epidemics in Persia. The Lancet Infectious Diseases, 15(12), 1480-1484.

Cherry, J. D. (2015a). Epidemic pertussis and acellular pertussis vaccine failure in the 21st century. Pediatrics, 135(6), 1130-1132.

Cherry, J. D. (2015b). The history of pertussis (whooping cough); 1906–2015: Facts, myths, and misconceptions. Current Epidemiology Reports, 2(2), 120-130.

Dorji, D., Mooi, F., Yantorno, O., Deora, R., Graham, R. M., & Mukkur, T. K. (2018). Bordetella pertussis virulence factors in the continuing evolution of whooping cough vaccines for improved performance. Medical Microbiology and Immunology, 207(1), 3-26.

Duncan, D. (2018). Whooping cough. Nurse Prescribing, 16(7), 316-319.

Garbiras, M., Shabaka, A., Calvo, N., Martin, L., Moreno, M. A., Lopez de la Manzanara, V., & Sanchez‐Fructuoso, A. I. (2016). Whooping cough in a renal transplant recipient. Transplant Infectious Disease, 18(2), 280-283.

Green, D., Labriola, G., Smeaton, L., & Falconer, M. (2017). Prevention of neonatal whooping cough in England: The essential role of the midwife. British Journal of Midwifery, 25(4), 224-228.

Hayles, E. H., Cooper, S. C., Wood, N., Sinn, J., & Skinner, S. R. (2015). What predicts postpartum pertussis booster vaccination? A controlled intervention trial. Vaccine, 33(1), 228-236.

Terry, J. B., Flatley, C. J., van den Berg, D. J., Morgan, G. G., Trent, M., Turahui, J. A.,… & Bell, G. J. (2015). A field study of household attack rates and the effectiveness of macrolide antibiotics in reducing household transmission of pertussis. Communicable Diseases Intelligence Quarterly Report, 39(1), E27-33.

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