Topic: Whooping cough | Around Akiba

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Whooping cough (from the French coqueluche; lat. Pertussis) is an acute anthroponous airborne bacterial infection, the most characteristic feature of which is a paroxysmal spasmodic cough. A dangerous infectious disease of the respiratory tract. Very dangerous for children under two years of age. Before the widespread introduction of the vaccine in the 1950s, whooping cough was one of the most common diseases in children. Causative agent It is caused by the bacteria Bordet-Zhangu (named after the Belgian scientist J. Bordet and the French scientist O. Zhangu, who first described it in 1906) (Bordetella pertussis). The innate immunity caused by maternal antibodies does not develop. Contagiousness (the probability of infection by contact) is 90%. In 1937, a microorganism similar to the whooping cough stick was isolated – the parapertussis stick. The disease caused by this microorganism proceeds as a mild form of whooping cough, but does not leave immunity to whooping cough. Disease development Children of preschool age get sick more often. The incubation period lasts from 7 to 14 days. Infection occurs through airborne droplets. The patient is contagious from the 1st to the 25th day of the disease. The duration of the infectious period can be shortened with timely antibiotic therapy. Infection occurs through airborne droplets through direct contact with an infected person. Carriage of bordetella pertussis has been observed in adults. Including among potentially dangerous contact persons there may be employees of preschool institutions, since the latent form of infection does not appear outwardly in any way. The patient is dangerous to the people around him for 30 days from the moment the first symptoms of the disease appear. There is no innate immunity to this type of infection. After the transferred disease, stable immunity is formed. A single vaccination gives a short-term effect, a repeated revaccination is required at the time specified in the vaccination calendar. It must be understood that immunity after vaccination does not guarantee complete protection. However, in such children, the disease is easier and faster, without provoking numerous complications. Although most cases of clinically significant whooping cough occurs in children aged 1 to 5 years, acute illness and death are recorded mainly in very young, non-immune children. Among older children, adolescents and adults, whooping cough is often underdiagnosed due to its often atypical course. However, older age groups are an important source of infection for susceptible infants. Even with treatment, a painful cough continues for ten weeks or more. There are no effective methods of dealing with whooping cough cough. Children under one year of age may have little or no cough and stop breathing instead. Adults with whooping cough cough so intensely that ribs break in 4% of patients. Epidemiological picture In each specific area, the disease becomes epidemic at intervals of 2-4 years. Immunization has markedly reduced the incidence of whooping cough in many countries. In the 1950s, before the introduction of immunization, more than 100,000 cases were reported annually in England. For comparison: in 1980 in England there were only 1,471 cases. Circulation of the even with very high vaccination coverage, while the vast majority of infected people do not develop symptoms; so, in a study conducted in the Netherlands in 1995-1996, the annual number of infected among the population over 3 years old was estimated at 6.6%, with the minimum carriage among children (3.3%) and the maximum – among the 20-24 age cohort (10.8%), while the registered diseases were only 0.01% The influx of labor migrants worsened the sanitary and hygienic situation in the Russian Federation, including the incidence of whooping cough. Immunity About half of the cases occur in children under 2 years of age, for them the disease is most dangerous. After the transferred disease, stable immunity is formed. Immunity after a single vaccination is not persistent and requires re-vaccination. A meta-study of acellular pertussis in 2018 estimates the effectiveness of the initial series of vaccines at 91% with a decrease in effectiveness of 9.6% annually, the effectiveness of revaccination in adolescence is estimated at 70% with a decrease in effectiveness of 45.3% annually; thus, the immunization completed in the second year of life provides a sufficiently high level of protection up to 4-6 years, but the effect of revaccination at an older age is lost very quickly. Early vaccination of women in the third of pregnancy results in efficient transplacental transfer of vaccine-derived antibodies from mother to infant; antibodies persist until the baby can start immunization at 3 months of age. One of the goals of the pertussis vaccination program, in addition to directly reducing the incidence and severity of the disease, is to protect unvaccinated infants from possible contact with the pathogen. Treatment Hospitalization is subject to: patients with severe forms; with life-threatening complications (impaired cerebral circulation and respiratory rhythm); with moderate forms with an uneven course, unfavorable premorbid[уточнить] background, exacerbation of chronic diseases; young children. According to epidemiological indications, children from closed children’s institutions (regardless of the severity of the disease) and family foci are hospitalized. Mode – sparing (reduction of negative psycho-emotional stress) with walks. Diet – enriched with vitamins, age appropriate. It is recommended to feed patients with severe forms of the disease more often and in smaller portions; after vomiting, children are fed. Etiotropic therapy – the appointment of antibiotics (macrolides, semi-synthetic penicillins, 3-generation cephalosporins). If the cough persists, then the further use of antibiotics is impractical. Pathogenetic therapy – anticonvulsants, sedatives. Symptomatic therapy – suction of mucus from the upper respiratory tract, aerosol therapy, physiotherapy, massage, breathing exercises. In the period of convalescence – vitamin and mineral complexes. Prophylaxis In most developed countries, the acellular (acellular) vaccine and its various combinations with other pediatric vaccines against poliomyelitis, hepatitis B, and hemophilic infection are used to vaccinate the population against whooping cough. In Russia In Russia, pertussis vaccinations are provided only for preschoolers: in the first year of life three times and in the second year of life once. The prevention of whooping cough in the country is regulated by the sanitary rules SP-3.1.2.3162-14. In Russia, the production of only whole-cell DTP vaccine is organized, which makes it difficult to include in the calendar various combinations of pediatric vaccines (for example, AaKDS + IPV, AaKDS + IPV + HepB, etc.), restricts the use of inactivated poliomyelitis vaccine as part of combined vaccines, does not allow the introduction of a calendar of regular booster doses of AaKDS-vaccines with a reduced amount of antigen among schoolchildren and the adult population of Russia. In 2014, the inclusion of 13-valent pneumococcal conjugate and 5-valent vaccines for the prevention of pertussis, diphtheria, tetanus and Hib in the Russian vaccination calendar became possible as a result of the partial localization of the production of modern immunobiological drugs in the country.