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Pertussis Pertussis (Whooping Cough) (Whooping Cough) Dr. Harivansh Chopra, Dr. Harivansh Chopra, DCH, MD DCH, MD Professor, Professor, Department of Community Medicine, Department of Community Medicine, LLRM Medical College, LLRM Medical College, Meerut. Meerut. [email protected] [email protected]

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Page 1: Pertussis (whooping cough) dr harivansh chopra

Pertussis Pertussis (Whooping Cough)(Whooping Cough)

Dr. Harivansh Chopra,Dr. Harivansh Chopra,DCH, MDDCH, MD

Professor,Professor,Department of Community Medicine,Department of Community Medicine,LLRM Medical College,LLRM Medical College,Meerut.Meerut. [email protected]@gmail.com

Page 2: Pertussis (whooping cough) dr harivansh chopra

ObjectivesObjectives

1.1. To study the epidemiology of Pertussis.To study the epidemiology of Pertussis.2.2. To study prevention and treatment of To study prevention and treatment of

Pertussis.Pertussis.

05/03/2305/03/23 22DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

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PertussisPertussis

1.1. Syadenham first Syadenham first used the term used the term “Pertussis”“Pertussis” (intense (intense cough) in1960.cough) in1960.

2.2. It is preferable to the It is preferable to the term term “whooping “whooping cough”cough” since most since most infected individuals infected individuals do not whoop. do not whoop.

05/03/2305/03/23 33DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

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EPIDEMIOLOGYEPIDEMIOLOGY

1.1. Worldwide distribution.Worldwide distribution.2.2. 16 Million cases in16 Million cases in 2008.2008. 95% in developing 95% in developing countries.countries. 195,000 deaths in 195,000 deaths in childrenchildren

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EPIDEMIOLOGYEPIDEMIOLOGY

1.29 LAC cases in1.29 LAC cases in 2010 GLOBALLY2010 GLOBALLY2 DPT 3 IMMUNIZATION 2 DPT 3 IMMUNIZATION RATE WAS 85%RATE WAS 85%

WHOWHO

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EPIDEMIOLOGYEPIDEMIOLOGY

3.3. Pertussis is endemic with epidemic Pertussis is endemic with epidemic cycles every 2 – 3 years after cycles every 2 – 3 years after accumulation of susceptible cohorts.accumulation of susceptible cohorts.

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India – Decline of PertussisIndia – Decline of Pertussis

83.7%

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05/03/2305/03/23 DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

88

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05/03/2305/03/23 DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

99

163000

26700

55070

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EPIDEMIOLOGYEPIDEMIOLOGY

4.4. Majority of cases Majority of cases occur from July occur from July through October.through October.

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EPIDEMIOLOGYEPIDEMIOLOGY

5.5. Extremely contagious, Extremely contagious, with attack rate as high with attack rate as high as 100% in susceptible as 100% in susceptible individuals exposed to individuals exposed to aerosol droplets at aerosol droplets at close range. close range.

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EPIDEMIOLOGYEPIDEMIOLOGY

6.6. Sub clinical Sub clinical infection is 50% in infection is 50% in fully immunized fully immunized and naturally and naturally immune individual.immune individual.

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Agent FactorAgent Factor

1.1. Agent is Agent is Bacillus pertussisBacillus pertussis in majority of cases.in majority of cases.

2.2. In 5% cases In 5% cases Bacillus Bacillus parapertussisparapertussis..

3.3. Bacillus pertussisBacillus pertussis does does not survives for prolonged not survives for prolonged periods in the environmentperiods in the environment

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Source of InfectionSource of Infection

1.1. A case of pertussis, which may be mild, A case of pertussis, which may be mild, missed or unrecognized.missed or unrecognized.

2.2. Chronic carriage by humans is not Chronic carriage by humans is not documented.documented.05/03/2305/03/23 1414DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA

(www.observerzparadise.com)(www.observerzparadise.com)

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Infective MaterialInfective Material

1.1. Nasopharyngeal and Nasopharyngeal and bronchial secretions – bronchial secretions – Droplet infection and Droplet infection and Direct contact.Direct contact.

2.2. Freshly contaminated Freshly contaminated fomites.fomites.

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Infective PeriodInfective Period

A week after A week after exposure to about exposure to about 3 weeks after the 3 weeks after the onset of the onset of the paroxysmal stage.paroxysmal stage.

Secondary Attack rate is 90%.

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Incubation PeriodIncubation Period

Ranges from 7 – 14 Ranges from 7 – 14 days.days.

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Host Factor – Age Host Factor – Age

1.1. Primarily a disease of infants and pre-Primarily a disease of infants and pre-school children. school children.

2.2. Higher incidence found below five years Higher incidence found below five years of age.of age.

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Host Factor – Age Host Factor – Age

3.3. Median age of infection :Median age of infection :1.1. Developing countries – 20-30 months.Developing countries – 20-30 months.2.2. Developed countries – 50 months.Developed countries – 50 months.

4.4. Infants < 6 months of age have highest mortality.Infants < 6 months of age have highest mortality.

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Female children show higher incidence Female children show higher incidence and mortality.and mortality.

Host Factor – SexHost Factor – Sex

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Host Factors - ImmunityHost Factors - Immunity

1.1. Infants are susceptible Infants are susceptible to infection from birth to infection from birth because there is no because there is no protection from maternal protection from maternal antibodies.antibodies.

2.2. Recovery from Pertussis Recovery from Pertussis and Adequate and Adequate Immunisation both lead Immunisation both lead to immunity.to immunity.

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Host Factors - ImmunityHost Factors - Immunity

3.3. Neither natural disease nor vaccination Neither natural disease nor vaccination provides complete or lifelong immunity provides complete or lifelong immunity against reinfection or disease.against reinfection or disease.

4.4. Protection begins to wane 3 – 5 yrs after Protection begins to wane 3 – 5 yrs after vaccination; unmeasurable after 12 yrs.vaccination; unmeasurable after 12 yrs.

5.5. Subclinical reinfection contributes Subclinical reinfection contributes significantly to immunity against disease, significantly to immunity against disease, ascribed to vaccine or prior infection.ascribed to vaccine or prior infection.05/03/2305/03/23 2222DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA

(www.observerzparadise.com)(www.observerzparadise.com)

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CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS

Catarrhal Stage

Paroxysmal Stage

Convalescent Stage

Due to long duration of the disease,Pertussis is also known as “100 day cough”.

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Catarrhal StageCatarrhal Stage

1.1. The stage lasts for 7-14 The stage lasts for 7-14 days.days.

2.2. It is the most infectious It is the most infectious period.period.

3.3. Features:Features:1.1. Low-grade fever.Low-grade fever.2.2. Sneezing.Sneezing.3.3. Lacrimation.Lacrimation.4.4. Conjunctival suffusion.Conjunctival suffusion.

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Catarrhal StageCatarrhal Stage

4.4. Cough:Cough:1.1. Not paroxysmal in early stages, but more Not paroxysmal in early stages, but more

annoying and frequent at night.annoying and frequent at night.2.2. Does not improve with passage of time, Does not improve with passage of time,

unlike upper respiratory tract infections.unlike upper respiratory tract infections.3.3. Paroxysmal nature of cough can be Paroxysmal nature of cough can be

suspected towards the later part of this suspected towards the later part of this phase.phase.05/03/2305/03/23 2525DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA

(www.observerzparadise.com)(www.observerzparadise.com)

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Paroxysmal PhaseParoxysmal Phase

1.1. This stage lasts for 2-4 This stage lasts for 2-4 weeks weeks

2.2. Cough:Cough:1.1. Initially dry, intermittent, Initially dry, intermittent,

irritative hack.irritative hack.2.2. Evolves into inexorable Evolves into inexorable

paroxysms.paroxysms.

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3.3. The bout of cough terminates with along The bout of cough terminates with along drawn out inspiratory crowing sound or drawn out inspiratory crowing sound or whoop.whoop.

Paroxysmal PhaseParoxysmal Phase

Cough is a forced expiratory effort against closed glottis.

Hear cough, click here05/03/2305/03/23 2727DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA

(www.observerzparadise.com)(www.observerzparadise.com)

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WhoopWhoopThe whoop is produced by the air rushing The whoop is produced by the air rushing in during inspiration through the half open in during inspiration through the half open glottis.glottis.

Hear whoop, click here05/03/2305/03/23 2828DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA

(www.observerzparadise.com)(www.observerzparadise.com)

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Paroxysmal PhaseParoxysmal Phase

4.4. The paroxysms of cough may occur every The paroxysms of cough may occur every hour, or even frequently, and may hour, or even frequently, and may terminate by vomiting.terminate by vomiting.

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5.5. The child may appear The child may appear chocked ,is unable to chocked ,is unable to breath, looks anxious breath, looks anxious and has suffused face.and has suffused face.

Paroxysmal PhaseParoxysmal Phase

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Paroxysmal PhaseParoxysmal Phase

6.6. The whoop may not always present in The whoop may not always present in infants, who present with apneic or infants, who present with apneic or cyanotic spells.cyanotic spells.

05/03/2305/03/23 3131DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

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Infants <3 mo do not display classical stages. After the most insignificant startle from a draught, light, sound, sucking, or stretching, a well-appearing young infant begins to choke, gasp, and flail extremities, with face reddened. Cough (expiratory grunt) may not be prominent.

05/03/2305/03/23 3232DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

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Whoop (forceful inspiratory gasp) infrequently occurs in infants <3 mo of age who are exhausted or lack muscular strength to create sudden negative intrathoracic pressure

05/03/2305/03/23 3333DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

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A well-appearing, playful toddler with similarly insignificant provocation suddenly expresses an anxious aura and may clutch a parent or comforting adult before beginning a machine-gun burst of uninterrupted coughs, chin and chest held forward, tongue protruding maximally, eyes bulging and watering, face purple, until coughing ceases and a loud whoop follows as inspired air traverses the still partially closed airway.05/03/2305/03/23 3434DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA

(www.observerzparadise.com)(www.observerzparadise.com)

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WhoopWhoopThe whoop is produced by the air rushing The whoop is produced by the air rushing in during inspiration through the half open in during inspiration through the half open glottis.glottis.

Hear whoop, click here05/03/2305/03/23 3535DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA

(www.observerzparadise.com)(www.observerzparadise.com)

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Adults describe a sudden feeling of strangulation followed by uninterrupted coughs, feeling of suffocation, bursting headache, diminished awareness, and then a gasping breath, usually without a whoop

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Convalescent PhaseConvalescent Phase

1.1. During convalescence, the interval between During convalescence, the interval between the paroxysms of cough increases and the paroxysms of cough increases and severity of episode decreases gradually.severity of episode decreases gradually.

2.2. Paradoxically, in infants, coughs and Paradoxically, in infants, coughs and whoop may become louder and more whoop may become louder and more classic in convalescence. classic in convalescence.

05/03/2305/03/23 3737DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

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Clinical Manifestations – Clinical Manifestations – Additional notesAdditional notes

1.1. Immunized children Immunized children have foreshortening of have foreshortening of all stages of pertussis.all stages of pertussis.

2.2. Adults have no distinct Adults have no distinct stages.stages.

05/03/2305/03/23 3838DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

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Case definitionCase definitionA suspected case of pertussis is defined as:A suspected case of pertussis is defined as:A person with a A person with a cough lasting at least two weekscough lasting at least two weeks with at with at least one of the following:least one of the following:

Paroxysms (i.e. fits) of coughingParoxysms (i.e. fits) of coughing Inspiratory whoopingInspiratory whooping Post-tussive vomitingPost-tussive vomiting Without other apparent causesWithout other apparent causes

ORORApnoea (with or without cyanosis)Apnoea (with or without cyanosis) in infants (age <1 year old) in infants (age <1 year old) with cough of with cough of any durationany durationORORIf a If a specialist physician strongly suspectsspecialist physician strongly suspects pertussis in a patient pertussis in a patient with cough ofwith cough of any durationany duration..

Page 40: Pertussis (whooping cough) dr harivansh chopra

3.3. In infants < 3months the catarrhal stage In infants < 3months the catarrhal stage is usually a few days or not recognized at is usually a few days or not recognized at all when apnea chocking or gasping all when apnea chocking or gasping cough herald the onset of disease.cough herald the onset of disease.

Clinical Manifestations – Clinical Manifestations – Additional notesAdditional notes

05/03/2305/03/23 4040DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

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MCQsMCQs

1. Which of the following is not true about Pertussis –

1. The other name is “Whooping cough”.2. The other name is “Hundred day cough”.3. Everyone suffering from it must have whoop.4. It is endemic with superimposed epidemic

cycles every 2-3 years.

Ans. – 3.05/03/2305/03/23 4141DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA

(www.observerzparadise.com)(www.observerzparadise.com)

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Diagnosis – ClinicalDiagnosis – Clinical1.1. High suspicion index in High suspicion index in

individual having pure or individual having pure or predominant complaint of cough predominant complaint of cough f/b vomitting, and f/b vomitting, and Absent:

1. Fever.2. Malaise / Myalgia.3. Exanthem / Enanthem.4. Sore throat, Hoarseness.5. Tachypnoea.6. Wheezes, Rales.

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Diagnosis – ClinicalDiagnosis – Clinical

2.2. In infants < 3 months In infants < 3 months of age, Apnea or of age, Apnea or Cyanosis (before Cyanosis (before appreciation of cough) appreciation of cough) is the clue – is the clue – occasionally cause of occasionally cause of Sudden Infant Death.Sudden Infant Death.

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1.1. Leukocytosis – 15,000-100,000cells/mmLeukocytosis – 15,000-100,000cells/mm33..1.1. Absolute lymphocytosis.Absolute lymphocytosis.2.2. Absolute increase in neutrophils Absolute increase in neutrophils

suggests a differential diagnosis or suggests a differential diagnosis or secondary bacterial infection. secondary bacterial infection.

Diagnosis – Blood pictureDiagnosis – Blood picture

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Laboratory diagnosisLaboratory diagnosis Culture of nasopharyngeal secretions Culture of nasopharyngeal secretions

considered bestconsidered best fastidious growth requirement s makes it difficult to fastidious growth requirement s makes it difficult to

isolateisolate chances of isolation maximum during catarrhal chances of isolation maximum during catarrhal

phase and declines rapidly after two weeksphase and declines rapidly after two weeks small window of opportunity for culture proven small window of opportunity for culture proven

diagnosisdiagnosis PCR PCR

detects DNA sequence of the bacteriadetects DNA sequence of the bacteria sensitivity decreases after 4 weeks of onsetsensitivity decreases after 4 weeks of onset

SerologySerology useful for diagnosis in useful for diagnosis in convalescent phaseconvalescent phase

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Diagnosis – Chest radiographDiagnosis – Chest radiograph

1.1. Only mildly abnormal – Only mildly abnormal – perihilar infiltrate or edema perihilar infiltrate or edema (sometimes butterfly (sometimes butterfly appearance), and variable appearance), and variable atelectasis.atelectasis.

2.2. Parenchymal consolidation Parenchymal consolidation suggests secondary bacterial suggests secondary bacterial infection.infection.

3.3. Occasional Pneumothorax, Occasional Pneumothorax, Pneumomediastinum, and air Pneumomediastinum, and air in soft tissues.in soft tissues.

Pertussis pneumonia with hyperaeration (air trapping)

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Diagnosis – Bacteriological testingDiagnosis – Bacteriological testing

1.1. Isolation of Isolation of Bacillus pertussisBacillus pertussis is the gold is the gold standard in diagnosis.standard in diagnosis.

2.2. Positive in catarrhal and paroxysmal Positive in catarrhal and paroxysmal stage.stage.

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Diagnosis – SerologyDiagnosis – Serology

1.1. Tests for detection of antibodies in acute Tests for detection of antibodies in acute and convalescent samples are most and convalescent samples are most sensitive tests in immunised individuals.sensitive tests in immunised individuals.

2.2. Antibody to PT raised >2S.D. indicates Antibody to PT raised >2S.D. indicates recent infection.recent infection.

3.3. Useful epidemiologically.Useful epidemiologically.05/03/2305/03/23 4848DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA

(www.observerzparadise.com)(www.observerzparadise.com)

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Differential DiagnosisDifferential Diagnosis

1.1. Adenoviral infections – Adenoviral infections – distinguishable by presence of distinguishable by presence of fever, sore throat, and fever, sore throat, and conjunctivitis.conjunctivitis.

2.2. Mycoplasma – distinguishable Mycoplasma – distinguishable by history of fever, headache, by history of fever, headache, & systemic symptoms; & systemic symptoms; frequent rales on chest frequent rales on chest auscultation.auscultation.

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Differential DiagnosisDifferential Diagnosis

3.3. Afebrile pneumonia Afebrile pneumonia ((Chlamydia trachomatisChlamydia trachomatis) – ) – distinguishable by staccato distinguishable by staccato cough (i.e. breath with every cough (i.e. breath with every cough), purulent conjunctivitis, cough), purulent conjunctivitis, tachypnea, rales.tachypnea, rales.

4.4. Afebrile pneumonia (RSV) – Afebrile pneumonia (RSV) – distinguishable by lower distinguishable by lower respiratory tract signs.respiratory tract signs.

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MCQsMCQs

3. Which of the following is diagnostic of pertusis

1. Leucocytosis with absolute lymphocytosis.2. Leucocytosis with relative lymphocytosis.3. Leucocytosis with neutropenia.4. Leucocytosis with eosinopenia.

Ans. – 1.05/03/2305/03/23 5151DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA

(www.observerzparadise.com)(www.observerzparadise.com)

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ComplicationsComplications

1.1. Apnea.Apnea.2.2. Secondary infections :Secondary infections :

a.a. Otitis media.Otitis media.b.b. Pneumonia.Pneumonia.

3.3. Flaring up of existing Flaring up of existing TB infection.TB infection.

4.4. Malnutrition.Malnutrition.

05/03/2305/03/23 5252DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

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Complications – Complications – Physical Physical sequel of forceful coughingsequel of forceful coughing

1.1. Conjuctival and Conjuctival and Scleral hemorrhage.Scleral hemorrhage.

2.2. Petechiae in upper Petechiae in upper body.body.

05/03/2305/03/23 5353DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

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3.3. Epistaxis.Epistaxis.

4.4. Hemorrhage in Hemorrhage in CNS and Retina.CNS and Retina.

Complications – Complications – Physical Physical sequel of forceful coughingsequel of forceful coughing

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5.5. Pneunomothorax.Pneunomothorax.

6.6. Subcutaneous emphysema.Subcutaneous emphysema.

7.7. Umbilical and inguinal Umbilical and inguinal hernia.hernia.

Complications – Complications – Physical Physical sequel of forceful coughingsequel of forceful coughing

05/03/2305/03/23 5555DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

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TreatmentTreatment

1.1. Antibiotics are useful only in the catarrhal Antibiotics are useful only in the catarrhal stage.stage.

2.2. Once the child goes in paroxysmal stage it Once the child goes in paroxysmal stage it is very difficult to abort the attack.is very difficult to abort the attack.

05/03/2305/03/23 5656DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

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TreatmentTreatment

1.1. Erythromycin 40-50 mg/kg/day in 4 divided Erythromycin 40-50 mg/kg/day in 4 divided doses X 14days. (Maximum 2 gm / 24 doses X 14days. (Maximum 2 gm / 24 hrs.)hrs.)

2.2. Respiratory Isolation for Respiratory Isolation for ≥ 5 days after ≥ 5 days after start of Erythromycin therapy.start of Erythromycin therapy.05/03/2305/03/23 5757DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA

(www.observerzparadise.com)(www.observerzparadise.com)

Page 58: Pertussis (whooping cough) dr harivansh chopra

Alternative drugsAlternative drugs

1.1. Clarithromycin 15-20 mg/kg/day in 2 div Clarithromycin 15-20 mg/kg/day in 2 div doses X 7 days. (Maximum 1 gm/24 hrs.)doses X 7 days. (Maximum 1 gm/24 hrs.)

2.2. Azithromycin 10 mg/kg/day once daily X 5 Azithromycin 10 mg/kg/day once daily X 5 days.days.

05/03/2305/03/23 5858DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

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Alternative drugsAlternative drugs

3.3. Ampicillin, Rifampicin and Cotrimoxazole Ampicillin, Rifampicin and Cotrimoxazole are modestly active against pertussis.are modestly active against pertussis.

4.4. The 1The 1stst and 2 and 2ndnd generation Cephalosporins generation Cephalosporins are not active against pertussis.are not active against pertussis.

05/03/2305/03/23 5959DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

Page 60: Pertussis (whooping cough) dr harivansh chopra

Recommended treatment and post-exposure Recommended treatment and post-exposure prophylaxis, by age groupprophylaxis, by age group

Age group Azithromycin Erythromycin Clarithromycin Alternate agent:

TMP-SMX

<1 month

Recommended drug; 10 mg/kg per day in a single dose x 5 days

40–50 mg/kg per day in 4 divided doses x 14 days

Not recommended.

Contraindicated in infants <2 months of age

1–5 months

10 mg/kg per day in a single dose x 5 days.

As above 15 mg/kg per day in 2 divided doses x 7 days.

For infants aged >2 months of age, TMP 8 mg/kg per day; SMX 40 mg/kg per day in 2 divided doses x 14 days.

Page 61: Pertussis (whooping cough) dr harivansh chopra

Age group Azithromycin Erythromycin Clarithromycin

Alternate agent: TMP-SMX

Children aged more than 6 months

10 mg/kg as a single dose on day 1 (maximum 500 mg); then 5 mg/kg per day as a single dose on days 2–5 (maximum 250 mg/day)

40 mg/kg per day in 4 divided doses for 7-14 days (maximum 1-2 g per day)

Maximum 1g/day

TMP 8 mg/kg per day; SMX 40 mg/kg per day in 2 divided doses x 14 days

Adolescents and adults

500 mg as a single dose on day 1 then 250 mg as a single dose on days 2–5

2g/day in 4 divided doses x 14 days

1g/day in 2 divided doses x 7 days

TMP 320 mg/day, SMX 1600mg/day in 2 divided doses x 14 days

RecommendedRecommended treatment and post-exposure treatment and post-exposure ProphylaxisProphylaxis, ,

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MCQsMCQs

2. The attack of pertussis can be aborted with the help of antibiotics only if the is treated :

1. In catarrhal stage.2. In paroxysmal stage.3. In convalescent stage.4. In all the above stages.

Ans. – 1.05/03/2305/03/23 6262DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA

(www.observerzparadise.com)(www.observerzparadise.com)

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MCQsMCQs

5. The drug of choice for the treatment of Pertusis & its dose is

1. Erythromycin 40-50 mg/kg/day2. Cephalexin 50-100 mg/kg/day3. Cotrimoxazole 5-8 mg/kg/day4. Tetracyclin 20-40 mg/kg/day

Ans. – 1.05/03/2305/03/23 6363DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA

(www.observerzparadise.com)(www.observerzparadise.com)

Page 64: Pertussis (whooping cough) dr harivansh chopra

Care of Household and Close Care of Household and Close Contacts – ChemoprophylaxisContacts – Chemoprophylaxis

Erythromycin 40-50 Erythromycin 40-50 mg/kg/day in 4 mg/kg/day in 4 divided doses X 14 divided doses X 14 days regardless of days regardless of age, history of age, history of immuinisation, and immuinisation, and symptoms.symptoms.

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Care of Household and Close Care of Household and Close Contacts – ImmunisationContacts – Immunisation

Situation for contact < 7 yearsSituation for contact < 7 years Recommendation Recommendation

Not vaccinated against pertussisNot vaccinated against pertussis Initiate Initiate vaccinationvaccination

Partially vaccinated against Partially vaccinated against pertussispertussis

Complete the Complete the recommended recommended scheduleschedule

Received 3Received 3rdrd dose > 6 mths. back dose > 6 mths. back Booster doseBooster doseReceived 4Received 4thth dose dose ≥ 3 years back≥ 3 years back Booster doseBooster dose

05/03/2305/03/23 6565DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

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PREVENTIONPREVENTIONVACCINES

PurifiedAcellularVaccine

Whole CellVaccine

05/03/2305/03/23 6666DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

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Whole cell vaccine (DTP) Whole cell vaccine (DTP)

1. Developed in late 1940s.2. Bacteria killed by heat or

formalin.3. Controversial because of

local and systemic side effects:

1. Redness, Pain, Swelling.2. Fever (30-70%).

05/03/2305/03/23 6767DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

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Whole cell vaccine (DTP) Whole cell vaccine (DTP)

4. National Childhood Encephalopathy Study (Britain) :

1. Infantile Spasms.2. Sudden Infant Death Syndrome (SIDS).

5. Efficacy :1. Three doses.2. 80 - 90% effective.

05/03/2305/03/23 6868DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

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Purified acellular vaccine Purified acellular vaccine (DTaP)(DTaP)

1. Introduced in 1981 by Japan.

2. Contains subcomponents of bacteria:

1. Filamentous Hemagglutinin (Fha).

2. Pertussis Toxin (PT).05/03/2305/03/23 6969DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA

(www.observerzparadise.com)(www.observerzparadise.com)

Page 70: Pertussis (whooping cough) dr harivansh chopra

Purified acellular vaccine (DTaP)Purified acellular vaccine (DTaP)

3. Efficacy1. Two doses.2. 70% protection against culture confirmed

infection.3. 80% protection against severe whopping

cough.

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DTP VaccineDTP Vaccine1. Content (BE ltd.):

1. Diptheria toxoid ≥20Lf to ≤30Lf.

2. Pertussis ≥4 IU.3. Tetanus toxoid ≥5Lf to ≤25Lf.

2.2. Dose – 0.5 ml.Dose – 0.5 ml.3.3. Route – Deep Route – Deep

intramuscular.intramuscular.4.4. Recommended site – Recommended site –

Antero-lateral part of thigh.Antero-lateral part of thigh.05/03/2305/03/23 7171DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA

(www.observerzparadise.com)(www.observerzparadise.com)

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Vaccination Schedule Vaccination Schedule

1. Immunization Policy :1. 3 DPT doses during first year of life.2. EPI recommendation 6, 10, 14 weeks.

2. Booster Policy :1. 4th DPT vaccine at 12 to 24 months.2. 5th DPT vaccine used by some countries

(In India, given 3 years after 4th dose).

05/03/2305/03/23 7272DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

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Contraindications to vaccinationContraindications to vaccination

1.1. Personal or strong family history of Personal or strong family history of epilepsy, convulsions or similar CNS epilepsy, convulsions or similar CNS disorders.disorders.

2.2. Any febrile upset until fully recovered.Any febrile upset until fully recovered.3.3. Reaction to one of the previously given Reaction to one of the previously given

triple vaccines. triple vaccines.

05/03/2305/03/23 7373DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

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MCQsMCQs

4. What is the correct composition of DPT vaccine

1. D ≥40Lf; P ≥4 IU; T ≥5Lf to ≤25Lf.2. D ≥20Lf to ≤30Lf; P ≥10 IU; T ≥5Lf to ≤25Lf.3. D ≥20Lf to ≤30Lf; P ≥4 IU; T ≥5Lf to ≤25Lf.4. D ≥20Lf to ≤30Lf; P ≥4 IU; T ≤25Lf.

Ans. – 3.05/03/2305/03/23 7474DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA

(www.observerzparadise.com)(www.observerzparadise.com)

Page 75: Pertussis (whooping cough) dr harivansh chopra

Diphtheria toxoid; Tetanus toxoid; Pertussis vaccine; Diphtheria toxoid 25 Lf, tetanus toxoid 10 Lf, purified Bordetella pertussis antigens (pertussis toxoid 25 mcg, filamentous haemagglutinin 25 mcg, 69 kDA outer membrane protein 8 mcg) per 0.5 mL; aluminium hydroxide (adsorbant),

05/03/2305/03/23 7575DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

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Dose: 0.5 mL IMI. Primary course: 3 doses at 2, 4 and 6 months, then 4th dose at 18 months, 5th dose at 4-5 years

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Page 77: Pertussis (whooping cough) dr harivansh chopra

2 TYPES OF VACCINES 2 TYPES OF VACCINES 1. Tdap

Combination Vaccine for Diphtheria, Pertussis & Tetanus

For all ages 11 years or more

For pregnant Women also

Page 78: Pertussis (whooping cough) dr harivansh chopra

05/03/2305/03/23 DR HARIVANSH CHOPRA DR HARIVANSH CHOPRA (www.observerzparadise.com)(www.observerzparadise.com)

7878

COMPOSITION OF BOOSTRIX

A.DIPHTHERIA TOXOID 2.5 LfB.TETANUS TOXOID 5LfC.PERTACTIN 2.5 mcgD.FHA 8mcgE.PT (INACTIVATED) 8 mcg

Page 79: Pertussis (whooping cough) dr harivansh chopra

Vaccination In PregnancyVaccination In Pregnancy IAP recommends that IAP recommends that

pregnant women receive the pregnant women receive the

whooping cough vaccine for whooping cough vaccine for

adolescents and adults adolescents and adults

(called Tdap vaccine) during (called Tdap vaccine) during

the third trimester of each the third trimester of each

pregnancy. pregnancy.

Page 80: Pertussis (whooping cough) dr harivansh chopra

Why vaccinate in pregnancy Why vaccinate in pregnancy only??only??

Page 81: Pertussis (whooping cough) dr harivansh chopra

Few other facts…Few other facts…

Vaccinate mother in third trimester of pregnancyVaccinate mother in third trimester of pregnancy

Vaccinate mother each time she is pregnantVaccinate mother each time she is pregnant

Breast feeding can transfer antibodies to infantBreast feeding can transfer antibodies to infant

Blood tests wont tell about the antibody titre in Blood tests wont tell about the antibody titre in

blood blood

Page 82: Pertussis (whooping cough) dr harivansh chopra

ConclusionsConclusions

1.1. Pertussis is a vaccine preventable Pertussis is a vaccine preventable disease caused by disease caused by Bacillus pertussis.Bacillus pertussis.

2.2. It is characterised by intensive cough It is characterised by intensive cough and whoop, and absence of other and whoop, and absence of other systemic features.systemic features.

3.3. Highly contagious disease – prophylaxis Highly contagious disease – prophylaxis of all contacts recommended.of all contacts recommended.

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