Tuesday, May 26 2020

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Whooping cough: an under-recognised disease

Update: April, 04/2020 - 18:57

 

Dr. Cynthia Dacanay. — Photo courtesy of Family Medical Practice

By Dr. Cynthia Dacanay*

Whooping cough or Pertussis, caused by the bacteria Bordetella pertussis, is a vaccine-preventable respiratory disease. It occurs year-round, but increases during summer and fall. Despite widespread vaccination, the number of cases worldwide has been rising since the 1980s, with peaks occurring every 3-5 years. Infants less than one year old have the highest number of reported cases among all age groups.

It is a highly contagious disease, developing in approximately 80-90 per cent of susceptible individuals who are exposed to it. It can spread by coughing, sneezing or sharing breathing space for extended periods of time. Usually there is a close contact, mostly the mother or a sibling, with a prolonged cough and no fever.

Initially, it will present like any other viral respiratory infection with runny nose, occasional mild cough, with or without fever. If fever is present, usually it is low-grade. However, after one to two weeks, there will be fits of numerous, rapid cough followed by a “whoop” sound. Vomiting and exhaustion occur afterward.

But sometimes, diagnosis is a challenge. Instead of the classic symptoms mentioned above, some will present differently.  In newborns, they may stop breathing temporarily instead of coughing fits. In older children, adults, and vaccinated individuals, they may have only mild cough or no symptoms at all. These non-specific symptoms may lead to its under-recognition.

Complications may arise and are usually severe in infants. It includes pneumonia, convulsions, hypotension, and even death.

Tests to detect the bacteria (culture and PCR) are widely available. However, depending on the test used, results may not be immediate. Hence, given the risk of serious complications in infants, immediate treatment should be started in those clinically suspected to have the disease. Laboratory confirmation should never delay treatment.

Antibiotics when administered early in the course may shorten the duration of symptoms and decrease spread to other individuals. Contact with the infected individual should be avoided until they have completed at least five days of treatment.

The importance of vaccine to prevent Pertussis cannot be overemphasized. It may not prevent it entirely but it has shown to decrease the duration and severity of the disease. People of all ages need the Pertussis vaccine, including infants as early as six weeks old, pre-teens, and adults including pregnant women. This is due to the inability of the vaccine to provide long-term immunity. Data shows that protection after immunisation wanes after 4-12 years. The reason behind giving Pertussis vaccine among pregnant women is that they will be able to pass on their antibodies to their newborn who remains unprotected until they start their primary immunisation. – Family Medical Practice.

*Dr. Cynthia Dacanay, a member of the Philippine Medical Association since 2001, completed her training as a general paediatrician in 2005 and was inducted as a diplomate of the Philippine Paediatric Society in 2009. Prior to coming to Việt Nam in 2011, she was a paediatric consultant in several tertiary hospitals in the Philippines. She is a certified provider of Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) and Paediatric Advanced Life Support (PALS). She loves to travel and read books in her spare time.

Family Medical Practice was the first foreign-owned primary healthcare provider in Việt Nam, and has consistently remained at the forefront of international-standard medicine since 1995. It offers extensive healthcare and emergency medical services nationwide to Vietnamese, expatriate and corporate customers.

For more advice on any medical topics, visit Family Medical Practice Hanoi at: 298 I Kim Mã, Ba Đình. Tel: (024) 3843 0748.  E: hanoi@vietnammedicalpractice.com.

FMP’s downtown Hồ Chí Minh location is: Diamond Plaza, 34 Lê Duẩn, District 1; 95 Thảo Điền, District 2. Tel: (028) 38227848. E: hcmc@vietnammedicalpractice.com

FMP Đà Nẵng is located at 96-98 Nguyễn Văn Linh, Hải Châu District, Đà Nẵng. Tel: (0236) 3582 699. E: danang@vietnammedicalpractice.com.

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