Pertussis – disease which cannot be forgotten
Klinika Pediatrii, Nefrologii i Alergologii Dziecięcej, Centralny Szpital Kliniczny MON WIM. Kierownik Kliniki: prof. dr hab. n. med. Anna Jung
Adres do korespondencji: Klinika Pediatrii, Nefrologii i Alergologii Dziecięcej CSK MON WIM, ul. Szaserów 128, 04‑141 Warszawa, tel.: 22 681 72 36, faks: 22 681 67 63
Praca finansowana ze środków własnych
PEDIATR MED RODZ Vol 8 Numer 4, p. 335-340
ABSTRACT
Pertussis (whooping cough) is an acute respiratory disease which may have a severe course, especially in newborns. Despite general conviction about disease eradication it is still a crucial clinical problem. Pertussis morbidity is different every year but the decreasing number of younger children and increasing number of people at the ages over 15 years falling ill could be observed. The main factors influencing the clinical course are age and immunization level. Among infants the disease mostly divides into three stages: catarrhal, paroxysmal and convalescent. Persistent cough is the most common manifestation of pertussis in adolescents and adults. The criterion standard for diagnosis of pertussis is isolation of B. pertussis in culture. Serologic antibody titre testing is available, but a comparison with results of the same test made 3‑5 weeks later is needed. The principle of prophylaxis is the obligatory vaccination carried out at the ages of 1, 2 and 6 years. For the first four doses usage of a whole cell vaccine (DTPw) is recommended. For the fifth dose at the age of 6 years an acellular pertussis vaccine (DTaP) should be used. The whole cell vaccine is contraindicated for prematurely born children and patients with cerebral palsy connected to perinatal hypoxia. Acquired immunity against whooping cough is decreasing with time. To eradicate B. pertussis from the respiratory tract macrolide antibiotics are the preferred agents or co‑trimoxazole if macrolides are contraindicated. Duration of treatment is 3‑5 days for azithromycin and 7‑14 days for the other macrolides and co‑trimoxazole. Prophylaxis for susceptible persons may be started up to 3 weeks after exposure. Such procedure is to the advantage of infants up to the age of 4 months and women in the third trimester of pregnancy.
Keywords: pertussis, persistent cough, pertussis toxin, DTaP, dTap