Prevention of whooping cough
Pregnancy booster injection
There is recent (2012) development in the prevention programme that is very important. Pregnant women can be immunized with a pertussis booster in the middle third of pregnancy. This is highly effective (90%) in preventing deaths from whooping cough in babies under 4 months before they are protected by their normal infant immunizations.
There is slightly different timing in different countries.
In the UK it is 16 to 32 weeks but it is worth giving right up to the end.
In the USA it is in the third trimester (27 to 36 weeks advised). USA CDC advice.
Herd immunity is important in this disease.
Whoopingcough-pertussis is a very serious disease for unimmunized babies (usually under 4 months old) and they can only by protected by giving a booster to the mother in pregnancy and by keeping a high HERD IMMUNITY in the general population by maintaining a high proportion of immunized individuals.
Unrecognised cases are an invisible source of infection.
Whoopingcough-pertussis is most common in teens and adults. Babies are most likely to get it from that source. About 3 to 6% of prolonged coughs in that age group are caused by whoopingcough-pertussis and the majority are unrecognised….hence the unseen danger.
Acellular vaccine (DTaP) is used in most developed countries.
Pertussis vaccine is usually given as an acellular version as DTaP in several doses in childhood, and in some countries (USA for example), every 10 years thereafter. Acellular vaccines have been use routinely for more than 20 years in most developed countries (2004 in the UK) and replaced the whole cell combination DTwP.
Whole cell (DTwP) vaccine works better.
DTwP gives longer lasting immunity than DTaP. The latter may only give protection for 3 to 5 years. Even the natural infection does not give protection for more than a few years (about 15 probably). But previous immunization always results in less serious disease if you should get it and it it is vital in the building of herd immunity to protect young babies.
Immunization stops it spreading as well as protecting against it. High uptake therefore vital.
The main effect of the vaccine is to greatly reduce the number of whooping cough cases in children. Although the children given direct protection in this way are not especially at risk from the disease (in the developed world) this protection indirectly stops their infant brothers and sisters (who are too young to be immunized) getting the illness and possibly dying from it.
Immunization prevents the disease but does not necessarily prevent the infection although it reduces the chance of passing it on by coughing, which is the main way. What is very clear but not properly appreciated is that immunisation, although imperfect, saves thousands of infant lives by preventing its main means of spread by coughing. But to be effective a high proportion of children need to be immunized.
If somebody has been exposed to whooping cough then prophylactic antibiotics should be given if prevention is deemed necessary.
The recommended antibiotic treatment is with Azithromycin or Clarithromycin. Dosage should be based on local prescribing recommendations. If this cannot be used then co-trimoxazole can be used. It is the same dosage for prevention as for treatment. In the UK Public Health England has published guidelines for professionals on how to manage the disease, including those exposed and at risk. This is the up to date 2018 version on their website.
If an outbreak should occur in a community such as a school or nursery where there are vulnerable individuals, it may best be controlled with both antibiotics and booster immunization of all individuals. A booster dose can give extra protection in as little as 2 weeks.
There are two vaccines licenced for adults and children in the UK, Repevax® and Boostrix®-IPV. These can be obtained from a pharmacy on prescription and need to be given under medical supervision. It boosts tetanus, diphtheria, pertussis and polio.
Different vaccine is required for boosting in older children and adults. Tdap is the usual designation. It had reduced diphtheria toxoid.
In the USA there is a similar vaccine called Adacel which is for 11-64 year olds. It contains Tetanus, diphtheria and acellular pertussis vaccine. It is made by Sanofi-Pasteur.
There is also Boostrix (GSK) Tdap which is similar and licenced for 10 years olds and older in the USA.