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Pertussis

Pertussis, also known as "whooping cough," is a highly contagious disease that is one of the leading causes of vaccine-preventable deaths. There are 30–50 million cases per year, and about 300,000 deaths per year. Virtually all deaths occur in children under one year of age. Ninety percent of all cases occur in developing countries. It is caused by certain species of the bacterium Bordetella—usually B. pertussis, but some cases are caused by B. parapertussis. more...

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Medicines

The disease was recognizably described as early as 1578 by Guillaume de Baillou (1538-1616), but earlier reports date back at least to the 12th century. B. pertussis was isolated in pure culture in 1906 by Jules Bordet and Octave Gengou. The complete B. pertussis genome of 4,086,186 base pairs was sequenced in 2002.

Characterization

The disease is characterized initially by mild respiratory infection symptoms such as cough, sneezing, and runny nose. After one to two weeks the cough changes character, with paroxysms of coughing followed by an inspiratory "whooping" sound. Coughing fits may be followed by vomiting not necessarily due to nausea but due to the sheer violence of the fit itself, which in severe cases leads to malnutrition. The fits, that do occur on their own, can also be triggered by yawning, stretching, laughing, or yelling. Coughing fits gradually diminish over one to two months. Other complications of the disease include pneumonia, encephalitis, pulmonary hypertension, and secondary bacterial superinfection.

Transmission

The disease is spread by contact with airborne discharges from the mucous membranes of infected people. Laboratory diagnosis include; Calcium alginate throat swab, culture on Bordet-Gengou medium, immunofluorescence and serological methods. Treatment of the disease with antibiotics (often erythromycin, azithromycin, clarithromycin or trimethoprim-sulfamethoxazole) results in the person becoming less infectious but probably does not significantly alter the outcome of the disease. Close contacts who receive appropriate antibiotics, "chemoprophylaxis", during the 7–21 day incubation period may be protected from developing symptomatic disease.

Vaccines

Pertussis vaccines were initially formulated in 1926—most notable by Dr. Louis W. Sauer of Northwestern University and Evanston Hospital—as whole-cell preparations, but are now available as acellular preparations, which cause fewer side effects. They offer protection for only a few years, and are given so that immunity lasts through childhood, the time of greatest exposure and greatest risk. The immunizations are often given in combination with tetanus and diphtheria immunizations, at ages 2, 4, and 6 months, and later at 15–18 months and 4–6 years. Traditionally, pertussis vaccines are not given after age seven, as the frequency of side effects associated with the immunization tends to increase with age. The most serious side-effects of immunization are neurological: they include seizures and hypotonic episodes. An acellular vaccine preparation for older individuals is available in Canada and Europe, and two such products are being evaluated for their safety in adolescents and adults in the United States; a Food and Drug Administration decision was approved for use of the vaccine for 11-64 year olds in August 2005.

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Persistent cough: pertussis rises in young adults and infants
From Science News, 11/6/04 by B. Harder

Nearly a century after a pertussis vaccine became available, the disease appears to be rebounding in adolescents and adults, a variety of studies shows. This trend could explain the increase in mortality among infants, who are infected through contact with family members and other caretakers.

Rarely fatal after the age of 2 years, pertussis can cause vomiting and "a cough that most adolescents or adults say they will never forget," says Carl-Heinz Wirsing von Konig of the hospital Klinikum Krefeld in Krefeld, Germany. The coughing spasms can cause urinary incontinence or break ribs, and the sound and the duration of the illness account for its nicknames, whooping cough and hundred-days cough.

As part of a childhood-vaccination program, begun in the 1960s, that also prevents tetanus and diphtheria, pertussis immunization has cut the disease's incidence among children. But immunity wanes within several years, and booster shots have not been routine. In the late 1970s and early 1980s, pertussis cases in many industrialized nations began rising among people whose immunity had waned. A rise has been apparent, too, among infants under 2 months old, who are too young to receive the vaccine.

What's more, in recent years, U.S. infant mortality from pertussis has approximately doubled, to about 20 cases per year. That's probably because parents and people who have contact with newborns are accidentally spreading the bacteria.

To understand changing infection patterns, Italian researchers analyzed several years' worth of data on European pertussis eases in different age groups.

Alberto Tozzi of Bambino Gesu Hospital in Rome and his colleagues found that adults and adolescents over 14 years old were more than twice as likely to get infected in 2002 as people of the same age had been in 1998. The researchers also found that infants are at far higher risk of infection than are people of any other age.

The researchers reported their findings on Oct. 30 at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy in Washington, D.C. There, other scientists discussed what to do about the resurgence of pertussis.

To combat the problem, vaccination practices need to change, says pediatrician Scott Halperin of Dalhousie University in Halifax, Nova Scotia. He recommends booster shots for all adolescents, especially because new pertussis vaccines are less likely than older ones to produce side effects such as fever and swelling. Canada, Australia, and many European countries recently instituted booster shot programs for students.

Researchers should also study whether vaccinating newborns or pregnant women could prevent infections in infancy, Halperin says. A potentially safer alternative for protecting infants, he says, is to revaccinate family members and other people likely to have contact with the babies.

Some researchers have been concerned that changes in the genetics of Bordetella pertussis, the most common pertussis-causing microbe, could underlie the disease's resurgence. Those bacteria have evolved since the 1960s, but they don't appear to have become more dangerous or more resistant to vaccines, says Nicole Guiso of the Institut Pasteur in Paris. Instead, she says, recent mutations in the bacteria may reflect their ongoing adaptation to living exclusively in people, which they appear to have done for fewer than 500 years.

COPYRIGHT 2004 Science Service, Inc.
COPYRIGHT 2004 Gale Group

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