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Whooping cough

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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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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New Pertussis vaccine safer for infants - Tripedia acellular whooping cough vaccine
From FDA Consumer, 10/1/96

An acellular vaccine recently licensed by FDA protects infants against pertussis, or "whooping cough," while causing fewer side effects than whole-cell pertussis vaccines.

Acellular pertussis vaccines contain only parts of the pertussis bacterium thought to be important for immunity, while whole-cell vaccines contain the whole, killed bacterium.

Currently, children in the United States receive a whole-cell pertussis vaccine in combination with diphtheria-tetanus toxoid, or DTP, at 2, 4 and 6 months of age, with additional doses of either a DTP or DT vaccine with an acellular pertussis component (DTaP) between 12 and 18 months and before entering elementary school.

The acellular vaccine licensed July 31 for the first three doses is one of two DTaP vaccines already approved for the fourth and fifth doses.

Pertussis is a highly communicable respiratory disease that can be especially serious for infants. The coughing and choking that occur make breathing difficult and can last for several weeks. Occasionally, infants can die from the disease.

According to the national Centers for Disease Control and Prevention, in 1994 and 1995 a total of approximately 9,500 cases of pertussis were reported in the United States. The World Health Organization reports that pertussis causes approximately 350,000 deaths worldwide.

Safety data from a number of studies indicate that the DTaP vaccines cause fewer adverse reactions than DTP vaccines in the first three doses. Reactions can include local redness or swelling, as well as fever, drowsiness, irritability, or prolonged, high-pitched crying. Studies are in progress to help determine the extent of these reactions when children receive the acellular pertussis vaccine for all five doses. Infrequent, serious events such as seizures have been reported after immunizations with both DTP and DTaP.

Two clinical studies were conducted to assess the efficacy of the pertussis component of this DTaP vaccine for infants. In these studies, the acellular pertussis vaccine was estimated to be between 69 and 80 percent effective in preventing pertussis, depending on the way the study was designed and completed. (The whole-cell vaccine is about 80 percent effective.)

Children who have begun their immunizations with DTP should continue to receive their fourth and fifth doses as DTaP. For those children who will now receive DTaP at 2, 4 and 6 months, a fourth dose of DTaP is recommended in the second year of life. Studies are being planned to help determine recommendations for the fifth dose.

The acellular pertussis component of the vaccine is produced by the Research Foundation for Microbial Diseases of Osaka University in Japan. It is combined with diphtheria and tetanus toxoids by Connaught Laboratories, Inc., Swiftwater, Pa., and is sold under the trade name Tripedia.

(See also "New Pertussis Vaccine Offers Prevention Alternative," in the September 1992 FDA Consumer.)

COPYRIGHT 1996 U.S. Government Printing Office
COPYRIGHT 2004 Gale Group

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