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Whooping Cough (Pertussis)

21 Oct 2023

Tags: Infection | Medical Emergencies

Introduction

Whooping cough, medically known as pertussis, stands as a highly contagious acute respiratory tract infection. Characterised by its distinctive “whoop” sound during severe coughing fits, whooping cough primarily affects infants and young children, posing a significant risk to their well-being.

As first responders and prehospital care providers, understanding the basics of whooping cough, its clinical presentation, and initial response is essential in delivering timely and appropriate care.

Prevalence / Prognosis

Whopping cough prevalence is influenced by vaccination rates, with higher coverage leading to fewer cases. However, periodic outbreaks can occur, especially in areas with lower vaccination rates.

The prognosis depends on factors such as age and vaccination status. Infants are at the greatest risk, with potential for severe complications, while older children and adults tend to have milder cases.

Whooping cough vaccine is given as part of the:

6 in 1 vaccine for babies at 8, 12 and 16 weeks (DTaP)

4 in 1 booster for children aged 3 years 4 months (Tdap)

Pregnancy between 16 and 32 weeks 

Aetiology

The aetiology of whooping cough, or pertussis, is primarily attributed to the bacterium Bordetella pertussis. This bacterium is responsible for causing the infection by colonising in the respiratory tract and releasing toxins that disrupt the respiratory system’s normal functioning.

The disease spreads through respiratory droplets with an incubation period of 6-20 days.

Whooping cough is most common in infants under three months and are unvaccinated. 

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Clinical Features / History 

Whooping cough exhibits distinct clinical features and has 4 stages in the progression of the infection.

Incubation Stage

Incubation period typically ranges from 6 to 20 days, during which the patient is asymptomatic and not contagious.

Catarrhal Stage

This stage starts with a mild, cold-like symptoms such as nasal discharge, low-grade fever, sore throat and occasional cough. This prodrome can last 1 to 2 weeks.

Paroxysmal Stage

After the catarrhal stage, the disease progresses to the paroxysmal stage, which is characterized by:

Severe, paroxysmal (sudden and intense) coughing fits.

The distinctive “whooping” sound when the patient gasps for air after a coughing episode.

Post-cough vomiting, which can be distressing for both children and adults.

Difficulty breathing and cyanosis (bluish skin or lips) during coughing fits.

Convalescent Stage

Following the paroxysmal stage, patients enter the convalescent stage, which can last for several weeks to months. During this stage, the cough gradsually lessens in severity and frequency.

Complications

Complications can be serious and, in some cases, life-threatening. Here are some of the potential complications associated with pertussis:

Pneumonia

Pneumonia is one of the most common and serious complications of pertussis. It can occur when the respiratory system becomes more susceptible to bacterial infections due to the damage caused by the pertussis bacterium.

Apnoea

Infants with pertussis are at risk of experiencing episodes of apnoea. This is especially concerning in young infants who are more vulnerable to respiratory distress.

Seizures

Pertussis can cause seizures, particularly in infants and young children. These seizures may result from a lack of oxygen during coughing fits or from the effects of toxins produced by the pertussis bacterium.

Dehydration

Frequent vomiting during coughing fits can lead to dehydration, particularly in infants. Dehydration can have serious health consequences and may require hospitalisation for fluid replacement.

Otitis Media

Ear Infections can be a complication of pertussis, especially in children. These infections can cause ear pain and discomfort.

Respiratory Failure

In rare and severe cases, pertussis can lead to respiratory failure, where the patient’s lungs are unable to provide adequate oxygen to the body. This is more likely to occur in infants and may require mechanical ventilation.

Encephalopathy

Can cause disruption in the functioning of the brain causing acute confusion or altered mental state.

Death

While relatively rare, pertussis can be fatal, especially in infants who are too young to be vaccinated or have not completed their vaccination series.

Management

Prehospital management of whooping cough (pertussis) focuses on stabilising the patient and provides supportive care.

Ensure patient’s airway is clear and patent and oxygen administration maybe be needed if hypoxic.

A low threshold for transporting children to hospital should be used, especially children aged under six months.

Other supportive care includes rest, hydration, and analgesics.

If transport to hospital is deemed unnecessary, contact should be made to a GP/senior paramedic to arrange a course of Macrolide antibiotics.

Whooping cough is a notifiable disease and relevant authorities should be made aware.

Alternative Diagnosis

Whooping cough, or pertussis, can have symptoms that overlap with other respiratory infections or conditions. Therefore, healthcare providers must consider alternative diagnoses when assessing patients with similar symptoms.

Acute cough could also be caused from:

Pneumonia

Upper Respiratory Tract Infection

Influenza

Chronic cough could also be caused from:

Asthma

GORD

COPD

Key Points

  • Whooping cough is a highly contagious bacterial infection caused by Bordetella pertussis. It primarily spreads through respiratory droplets when an infected person coughs or sneezes, making it easily transmissible, especially in close-contact settings.

  • Vaccination is a primary prevention strategy for whooping cough. Infants and young children are vaccinated with the DTaP vaccine, while adolescents and adults receive the Tdap vaccine as a booster.

  • Whooping cough can lead to various complications, particularly in infants and young children, including pneumonia, seizures, encephalopathy, and respiratory failure.

Bibliography

Gopal, D. P., Barber, J., & Toeg, D. (2019). Pertussis (whooping cough). BMJ, 364, l401. https://doi.org/10.1136/bmj.l401

Joint Royal Colleges Ambulance Liaison Committee and Association of Ambulance Chief Executives (2022). JRCALC Clinical Guidelines 2022. Class Professional Publishing

NHS Choices. (2019, November 13). Whooping cough. NHS. https://www.nhs.uk/conditions/Whooping-cough/

Introduction

Whooping cough, medically known as pertussis, stands as a highly contagious acute respiratory tract infection. Characterised by its distinctive “whoop” sound during severe coughing fits, whooping cough primarily affects infants and young children, posing a significant risk to their well-being.

As first responders and prehospital care providers, understanding the basics of whooping cough, its clinical presentation, and initial response is essential in delivering timely and appropriate care.

Prevalence / Prognosis

Whooping cough, medically known as pertussis, stands as a highly contagious acute respiratory tract infection. Characterised by its distinctive “whoop” sound during severe coughing fits, whooping cough primarily affects infants and young children, posing a significant risk to their well-being.

As first responders and prehospital care providers, understanding the basics of whooping cough, its clinical presentation, and initial response is essential in delivering timely and appropriate care.

Aetiology

The aetiology of whooping cough, or pertussis, is primarily attributed to the bacterium Bordetella pertussis. This bacterium is responsible for causing the infection by colonising in the respiratory tract and releasing toxins that disrupt the respiratory system’s normal functioning.

The disease spreads through respiratory droplets with an incubation period of 6-20 days.

Whooping cough is most common in infants under three months and are unvaccinated.

Clinical Features / History

Whooping cough exhibits distinct clinical features and has 4 stages in the progression of the infection.

Incubation Stage

Incubation period typically ranges from 6 to 20 days, during which the patient is asymptomatic and not contagious.

Catarrhal Stage

This stage starts with a mild, cold-like symptoms such as nasal discharge, low-grade fever, sore throat and occasional cough. This prodrome can last 1 to 2 weeks.

Paroxysmal Stage

After the catarrhal stage, the disease progresses to the paroxysmal stage, which is characterized by:

Severe, paroxysmal (sudden and intense) coughing fits.

The distinctive “whooping” sound when the patient gasps for air after a coughing episode.

Post-cough vomiting, which can be distressing for both children and adults.

Difficulty breathing and cyanosis (bluish skin or lips) during coughing fits.

Convalescent Stage

Following the paroxysmal stage, patients enter the convalescent stage, which can last for several weeks to months. During this stage, the cough gradsually lessens in severity and frequency.

    Complications

    Complications can be serious and, in some cases, life-threatening. Here are some of the potential complications associated with pertussis:

    Pneumonia

    Pneumonia is one of the most common and serious complications of pertussis. It can occur when the respiratory system becomes more susceptible to bacterial infections due to the damage caused by the pertussis bacterium.

    Apnoea

    Infants with pertussis are at risk of experiencing episodes of apnoea. This is especially concerning in young infants who are more vulnerable to respiratory distress.

    Seizures

    Pertussis can cause seizures, particularly in infants and young children. These seizures may result from a lack of oxygen during coughing fits or from the effects of toxins produced by the pertussis bacterium.

    Dehydration

    Frequent vomiting during coughing fits can lead to dehydration, particularly in infants. Dehydration can have serious health consequences and may require hospitalisation for fluid replacement.

    Otitis Media

    Ear Infections can be a complication of pertussis, especially in children. These infections can cause ear pain and discomfort.

    Respiratory Failure

    In rare and severe cases, pertussis can lead to respiratory failure, where the patient’s lungs are unable to provide adequate oxygen to the body. This is more likely to occur in infants and may require mechanical ventilation.

    Encephalopathy

    Can cause disruption in the functioning of the brain causing acute confusion or altered mental state.

    Death

    While relatively rare, pertussis can be fatal, especially in infants who are too young to be vaccinated or have not completed their vaccination series.

    Management

    Prehospital management of whooping cough (pertussis) focuses on stabilising the patient and provides supportive care.

    Ensure patient’s airway is clear and patent and oxygen administration maybe be needed if hypoxic.

    A low threshold for transporting children to hospital should be used, especially children aged under six months.

    Other supportive care includes rest, hydration, and analgesics.

    If transport to hospital is deemed unnecessary, contact should be made to a GP/senior paramedic to arrange a course of Macrolide antibiotics.

    Whooping cough is a notifiable disease and relevant authorities should be made aware.

    Alternative Diagnosis

    Whooping cough, or pertussis, can have symptoms that overlap with other respiratory infections or conditions. Therefore, healthcare providers must consider alternative diagnoses when assessing patients with similar symptoms.

    Acute cough could also be caused from:

    Pneumonia

    Upper Respiratory Tract Infection

    Influenza

    Chronic cough could also be caused from:

    Asthma

    GORD

    COPD

    Key Points

    • Whooping cough is a highly contagious bacterial infection caused by Bordetella pertussis. It primarily spreads through respiratory droplets when an infected person coughs or sneezes, making it easily transmissible, especially in close-contact settings.

    • Vaccination is a primary prevention strategy for whooping cough. Infants and young children are vaccinated with the DTaP vaccine, while adolescents and adults receive the Tdap vaccine as a booster.

    • Whooping cough can lead to various complications, particularly in infants and young children, including pneumonia, seizures, encephalopathy, and respiratory failure.

    Bibliography

    Gopal, D. P., Barber, J., & Toeg, D. (2019). Pertussis (whooping cough). BMJ, 364, l401. https://doi.org/10.1136/bmj.l401

    Joint Royal Colleges Ambulance Liaison Committee and Association of Ambulance Chief Executives (2022). JRCALC Clinical Guidelines 2022. Class Professional Publishing

    NHS Choices. (2019, November 13). Whooping cough. NHS. https://www.nhs.uk/conditions/Whooping-cough/

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