Pertusis / મોટી ઉધરસ

1) What causes pertussis?
Pertussis is caused by a bacterium, Bordetella pertussis.

2) How does pertussis spread?
Pertussis is spread through the air by infectious droplets
and is highly contagious.

3) How long does it take to show signs of pertussis after being exposed?
The incubation period of pertussis is commonly seven
to 10 days, with a range of 4–21 days.

4) What are the symptoms of pertussis?
Pertussis disease can be divided into three stages:
Catarrhal stage: can last 1–2 weeks and includes a
runny nose, sneezing, low-grade fever, and a mild
cough (all similar symptoms to the common cold).
Paroxysmal stage: lasts 1–6 weeks, but can persist
for up to 10 weeks. The characteristic symptom is a
burst, or paroxysm, of numerous, rapid coughs. At
the end of the paroxysm the patient suffers from a
long inhaling effort that is characterized by a highpitched
whoop (hence the name, “whooping cough”).
Infants and young children often appear very ill and
distressed, and may turn blue and vomit.
Convalescent stage: usually lasts 2–6 weeks, but may
last for months. Although the cough usually disappears
after 2–3 weeks, paroxysms may recur whenever
the patient suffers any subsequent respiratory
infection. The disease is usually milder in adolescents
and adults, consisting of a persistent cough similar
to that found in other upper respiratory infections.
However, these individuals are still able to transmit
the disease to others, including unimmunized or incompletely
immunized infants.

5) How serious is pertussis?
Pertussis can be a very serious disease, especially for
infants. Rates of hospitalization and complications
increase with decreasing age. During the two-year
period 2004–05, a total of 66 deaths from pertussis
were reported to CDC. Children age 3 months and
younger accounted for 85% of these deaths.
As noted above in the section on symptoms, the
breathing difficulties associated with this disease can
be very distressing and scary for the patient and his
or her family.
Although adults are less likely than infants to become
seriously ill with pertussis, most make repeated visits
for medical care and miss work, especially when
pertussis is not initially considered as a reason for
their long-term cough. In addition, adults with pertussis
infection have been shown to be an important
source of infection to infants with whom they have
close contact.

6) What are possible complications from pertussis?
Younger patients have a greater chance of complications
from pertussis than older patients. The most
common complication is secondary bacterial infection,
which is the cause of most pertussis-related
deaths. Pneumonia occurs in one out of 20 cases;
this percentage is higher for infants younger than
age 6 months. Infants are also more likely to suffer from such neurologic
complications such as seizures and encephalopathy,
probably due to the reduction of oxygen
supply to the brain. Other less serious complications
include ear infection, loss of appetite, and dehydration.
Adults with pertussis can have complications such as
pneumonia (up to 5% of cases) and rib fracture from
coughing (up to 4% of cases). Other reported side
effects include (among others), loss of consciousness,
female urinary incontinence, hernias, angina,
and weight loss.

7) How do I know if my child has pertussis?
The diagnosis of pertussis is usually made based on
its characteristic history and physical examination.
A laboratory test may be done, which involves taking
a specimen from the back of the patient’s throat
(through the nose).

8) Is there a treatment for pertussis?
Antibiotics are somewhat helpful in treating pertussis.
The drug of choice is usually erythromycin that
is given to all household and other close contacts of
the patient to minimize transmission, regardless of
age and vaccination status.
All close contacts younger than seven years of age
should complete their DTaP vaccine series if they
have not already done so. If they have completed
their primary four dose series, but have not had a dose within the last three years, they should be given a booster dose.
Patients also need supportive therapy such as bed
rest, fluids, and control of fever.

9) How long is a person with pertussis contagious?
Persons with pertussis are most infectious during the
catarrhal period and during the first two weeks after
onset of the cough (approximately 21 days).

10) Can you get pertussis more than once?
Reinfection appears to be uncommon but does occur.
With natural infection, immunity to pertussis will
likely wane as soon as seven years following disease;
reinfection may present as a persistent cough, rather
than typical pertussis. Unfortunately, it is difficult
to verify pertussis infection with existing laboratory
methods.
If someone has a recent culture-documented case
of pertussis, he or she may not need immediate immunization
against pertussis; however, a vaccine
containing pertussis antigen will not be harmful,
and they should continue on the routine immunization
schedule for future protection against tetanus,
diphtheria, and pertussis. If culture is lacking, even
with a history of pertussis, do NOT withhold a dose
of pertussis vaccine, if it is recommended per the
routine schedule.
11) When did pertussis vaccine become available?
The first whole-cell pertussis vaccine was developed
in the 1930s and was in widespread use by the mid-
1940s, when pertussis vaccine was combined with
diphtheria toxoid and tetanus toxoid to make the
combination DTP vaccine.
In 1991, DTaP vaccine was licensed in the United
States. The pertussis component of this vaccine is
a more purified “acellular” version, which produces
fewer side effects.
In 2005, two new tetanus toxoid-diphtheria-acellular
pertussis (Tdap) vaccines were licensed. These vaccines
are the first acellular pertussis-containing vaccines
that make it possible to vaccinate adolescents
and adults against pertussis.
Pertussis is not available as a single vaccine.

12) What kind of vaccine is it?
DTaP and Tdap vaccines are “inactivated” vaccines.
Inactivated vaccines do not contain live bacteria or
virus and cannot reproduce, which is why multiple
doses are needed to produce immunity.
For the pertussis component of DTaP and Tdap vaccines,
purified components of the bacterium are
grown and then inactivated. DTaP is for children
younger than 7 years and has a higher concentration
of pertussis than Tdap, which is intended for persons
10 years and older.

13) How is this vaccine given?
The DTaP and Tdap vaccines are given as a shot in
the muscle.

14) Is there more than one brand of pertussis vaccine?
At the present time, there are three different brands
of DTaP vaccines available in the U.S. All three vaccines
are equally effective and safe, and are given on
the same schedule at two, four, six, 15–18 months,
and 4–6 years. DTaP is also part of four childhood
combination vaccines that include other vaccines
(e.g., IPV, Hib, HepB). Two companies produce the
Tdap vaccines that are approved for use in adolescents
and adults through the age of 64 years.

15) Who should get this vaccine?
All infants should receive DTaP vaccine as part of
their routine immunization unless they have a medical
reason not to. Persons 10 years and older should
receive Tdap vaccine in place of a one-time routine
booster dose of adult Td vaccine.
Women who are pregnant or who have recently given
birth should be given a one-time dose of Tdap
to protect their newborn. Because other adults who
have close contact with infants also pose a risk of spreading pertussis to the infant, family members
and other caregivers of new infants should receive
Tdap vaccine.
Tdap vaccine is also recommended for healthcare
personnel in hospitals and ambulatory care settings
who have direct patient contact, especially those
working with infants, regardless of when they received
their previous dose of Td vaccine.

16) How many doses of DTaP vaccine are required?
The usual schedule for infants is a series of four
doses given at two, four, six, and 15–18 months
of age. A fifth dose, or booster, is recommended at
4–6 years of age, unless the fourth dose was given
late (after the fourth birthday). All adolescents and
adults younger than age 65 years should receive a
one-time dose of Tdap.

17) How safe is this vaccine?
Most children have no serious reactions from this
combined vaccine. The most common reactions are
local reactions at the injection site, such as soreness,
redness, and swelling, especially after the fourth or
fifth dose. Other possible reactions may include
fussiness, mild fever, loss of appetite, tiredness, and
vomiting. The use of the more purified DTaP instead
of the whole cell DTP has decreased these mild reactions
substantially. Tdap is a new vaccine but trials
have shown it to be safe.

18) What side effects have been reported with this vaccine?
About 20%–40% of children have some local reaction
such as pain, redness, or swelling after the first
three doses of DTaP. Such local reactions seem to be
more frequent after the fourth and/or fifth doses.
A temperature of 101° F or higher is reported in
3%–5% of DTaP recipients. Less common reactions
(e.g., persistent crying, higher fever, febrile seizure)
are rare and generally occur in fewer than 1 in
10,000 doses.
If a child has a medical reason not to receive the pertussis
vaccine, they can and should still be vaccinated
against diphtheria and tetanus with DT (pediatric)
vaccine.
The most frequently reported side effects following
vaccination with Tdap are headache, generalized
body aches, and tiredness.

19) How effective is this vaccine?
In general, inactivated vaccines are not as effective in
producing immunity as are live vaccines. In studies
of acellular pertussis vaccine, children who received
three or four doses were 80%–85% less likely to develop
pertussis than unvaccinated children. Tdap
vaccine is believed to be similar in effectiveness and
duration of immunity as pediatric DTaP vaccines.
Who should NOT receive pertussis vaccine?
People who had a serious allergic reaction to a previous
dose of DTaP or Tdap vaccine, or who developed
encephalopathy (brain injury) not due to another
identifiable cause, should not receive another
dose.
Certain rare adverse events following pertussis vaccination
usually serve as a precaution against receiving
further doses. Such events include a temperature of
105°F or higher, collapse or shock-like state, persistent
crying for more than three hours, or convulsions
within three days. Even if one of these precautions
exists, there may be occasions when the benefit
of immunization outweighs the risk (for example,
during a community-wide outbreak of pertussis). A
person who developed one of these adverse events
after pediatric DTaP vaccine may receive Tdap as an
adolescent or adult.
A person with a recognized, possible, or potential
neurologic condition should delay receiving DTaP
or Tdap vaccine until the condition is evaluated,
treated, and/or stabilized. Although DTaP vaccine
does not cause neurological disorders, receiving the
vaccine can cause an already-present underlying
condition to show itself.
Persons with a moderate or severe illness should
postpone receiving the vaccine until they are well.

20) Can the vaccine cause pertussis?
No.

21) Can a pregnant woman receive Tdap vaccine?
Tdap is not contraindicated during pregnancy. It
should be administered to a pregnant woman who
is in contact with an infant younger than age 12
months, is in an outbreak setting, or is a healthcare
provider who sees children. If there is no risk to
the pregnant woman of acquiring or transmitting
pertussis, the CDC’s Advisory Committee on Immunization
Practices recommends that Tdap vaccination
be deferred until the immediate postpartum period.
The new mother should receive Tdap before hospital
discharge, even if she is breastfeeding.