Last month, I asked the obstetrician if she could vaccinate my wife against pertussis, or whooping cough. Her answer was: “It is not recommended.”
And yet globally, there is a resurgence of this previously controlled vaccine-preventable disease.
Whooping cough is a disease that affects people at any age. However, it is most severe in infants, especially in the first few weeks and months of life.
The problem is that since we do not vaccinate babies against this infection until six or eight weeks of life, they are at great risk during the first two to three months of life.
Therefore, to combat this disease, what some developed countries do is to vaccinate women late in their pregnancy.
The mother then produces antibodies that cross the placenta into the baby’s body.
That way, by the time the baby is born, it has its own antibodies to protect it against pertussis long before it is eligible for its own vaccination at six weeks.
SIGNIFICANT DEATH TOLL
Pertussis is a disease that has a significant death toll worldwide. Most of these deaths occur in unvaccinated or incompletely vaccinated children.
Adolescents and adults are important reservoirs for the organism and are frequent sources of infection for infants.
This is because the protective immunity against pertussis given to most of us when we are young wanes anywhere from four to 12 years after the last immunisation.
In fact, infants mainly contract pertussis from the people in their close environment, including parents, siblings, babysitters, and even grandparents.
As a result, booster doses are needed in older children and adolescents.
In addition to vaccinating pregnant women, immediate family members and planned direct caregivers should also receive a pertussis vaccination at least two weeks before planned infant contact.
This concept of cocooning provides indirect protection to vulnerable infants by immunising adults and other individuals around them.
Close contact accounts for 35-68 per cent of pertussis infection in infants and if these are immunised, they will not be infected and pass it on to the newborn.
Mothers are the most common source of infection to their babies.
Pertussis is a highly contagious disease transmitted via droplets through coughing, sneezing, or speaking.
About 80-90 per cent of people who are exposed and not immune will develop the disease.
Individuals are often unaware that they are infected in the first place. As a result, the disease is often under-recognised, under-reported, and under-treated in adolescents and adults.
The symptoms are not specific and include a runny nose, low grade fever, and mild but persistent cough that worsens at night.
Like tuberculosis, pertussis disease should be considered in anyone with a nasty, persistent cough lasting longer than two weeks.
I once saw a patient whose cough was so severe that she broke two of her ribs. In babies, fits of numerous, rapid barking coughs are followed by a “whoop” sound.
Pertussis infection can be successfully treated with antibiotics. It is important to treat pertussis as early as possible.
Healthcare workers are not spared either. A recent study at a teaching university hospital in São Paulo, Brazil, revealed that 17 per cent of the healthcare workers in the emergency department, including paediatricians and nurses, were infected although they did not even know that they were.
It is almost impossible to avoid exposure to pertussis. The best protection is vaccination.
Vaccination should be employed for infants but booster doses throughout life for adolescents and adults should also be considered.
Dr Obwogo is a medical doctor and senior quality improvement adviser working for an international NGO. [email protected]