Más contenido relacionado


Pertussis (whooping cough) dr harivansh chopra

  1. PertussisPertussis (Whooping Cough)(Whooping Cough) Dr. Harivansh Chopra,Dr. Harivansh Chopra, DCH, MDDCH, MD Professor,Professor, Department of Community Medicine,Department of Community Medicine, LLRM Medical College,LLRM Medical College, Meerut.Meerut.
  2. ObjectivesObjectives 1.1. To study the epidemiology of Pertussis.To study the epidemiology of Pertussis. 2.2. To study prevention and treatment ofTo study prevention and treatment of Pertussis.Pertussis. 10/24/1610/24/16 22DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  3. PertussisPertussis 1.1. Syadenham firstSyadenham first used the termused the term “Pertussis”“Pertussis” (intense(intense cough) in1960.cough) in1960. 2.2. It is preferable to theIt is preferable to the termterm “whooping“whooping cough”cough” since mostsince most infected individualsinfected individuals do not not whoop. 10/24/1610/24/16 33DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  4. EPIDEMIOLOGYEPIDEMIOLOGY 1.1. Worldwide distribution.Worldwide distribution. 2.2. 16 Million cases in16 Million cases in 2008.2008. 95% in developing95% in developing countries.countries. 195,000 deaths in195,000 deaths in childrenchildren 10/24/1610/24/16 44DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  6. EPIDEMIOLOGYEPIDEMIOLOGY 3.3. Pertussis is endemic with epidemicPertussis is endemic with epidemic cycles every 2 – 3 years aftercycles every 2 – 3 years after accumulation of susceptible cohorts.accumulation of susceptible cohorts. 10/24/1610/24/16 66DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  7. India – Decline of PertussisIndia – Decline of Pertussis 83.7% 10/24/1610/24/16 77DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  9. 10/24/1610/24/16 DR HARIVANSH CHOPRADR HARIVANSH CHOPRA ( 99 163000 26700 55070
  10. EPIDEMIOLOGYEPIDEMIOLOGY 4.4. Majority of casesMajority of cases occur from Julyoccur from July through October.through October. 10/24/1610/24/16 1010DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  11. EPIDEMIOLOGYEPIDEMIOLOGY 5.5. Extremely contagious,Extremely contagious, with attack rate as highwith attack rate as high as 100% in susceptibleas 100% in susceptible individuals exposed toindividuals exposed to aerosol droplets ataerosol droplets at close range.close range. 10/24/1610/24/16 1111DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  12. EPIDEMIOLOGYEPIDEMIOLOGY 6.6. Sub clinicalSub clinical infection is 50% ininfection is 50% in fully immunizedfully immunized and naturallyand naturally immune individual.immune individual. 10/24/1610/24/16 1212DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  13. Agent FactorAgent Factor 1.1. Agent isAgent is BacillusBacillus pertussispertussis in majority ofin majority of cases.cases. 2.2. In 5% casesIn 5% cases BacillusBacillus parapertussisparapertussis.. 3.3. Bacillus pertussisBacillus pertussis doesdoes not survives for prolongednot survives for prolonged periods in theperiods in the environmentenvironment 10/24/1610/24/16 1313DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  14. Source of InfectionSource of Infection 1.1. A case of pertussis, which may be mild,A case of pertussis, which may be mild, missed or unrecognized.missed or unrecognized. 2.2. Chronic carriage by humans is notChronic carriage by humans is not documented.documented.10/24/1610/24/16 1414DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  15. Infective MaterialInfective Material 1.1. Nasopharyngeal andNasopharyngeal and bronchial secretions –bronchial secretions – Droplet infection andDroplet infection and Direct contact.Direct contact. 2.2. Freshly contaminatedFreshly contaminated fomites.fomites. 10/24/1610/24/16 1515DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  16. Infective PeriodInfective Period A week afterA week after exposure to aboutexposure to about 3 weeks after the3 weeks after the onset of theonset of the paroxysmal stage.paroxysmal stage. Secondary Attack rate is 90%. 10/24/1610/24/16 1616DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  17. Incubation PeriodIncubation Period Ranges from 7 – 14Ranges from 7 – 14 days.days. 10/24/1610/24/16 1717DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  18. Host Factor – AgeHost Factor – Age 1.1. Primarily a disease of infants and pre-Primarily a disease of infants and pre- school children. 2.2. Higher incidence found below five yearsHigher incidence found below five years of age.of age. 10/24/1610/24/16 1818DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  19. Host Factor – AgeHost Factor – Age 3.3. Median age of infection :Median age of infection : 1.1. Developing countries – 20-30 months.Developing countries – 20-30 months. 2.2. Developed countries – 50 months.Developed countries – 50 months. 3.3. Infants < 6 months of age have highestInfants < 6 months of age have highest mortality.mortality.10/24/1610/24/16 1919DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  20. Female children show higher incidenceFemale children show higher incidence and mortality.and mortality. Host Factor – SexHost Factor – Sex 10/24/1610/24/16 2020DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  21. Host Factors - ImmunityHost Factors - Immunity 1.1. Infants are susceptibleInfants are susceptible to infection from birthto infection from birth because there is nobecause there is no protection from maternalprotection from maternal antibodies.antibodies. 2.2. Recovery from PertussisRecovery from Pertussis and Adequateand Adequate Immunisation both leadImmunisation both lead to immunity. 10/24/1610/24/16 2121DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  22. Host Factors - ImmunityHost Factors - Immunity 3.3. Neither natural disease nor vaccinationNeither natural disease nor vaccination provides complete or lifelong immunityprovides complete or lifelong immunity against reinfection or disease.against reinfection or disease. 4.4. Protection begins to wane 3 – 5 yrs afterProtection begins to wane 3 – 5 yrs after vaccination; unmeasurable after 12 yrs.vaccination; unmeasurable after 12 yrs. 5.5. Subclinical reinfection contributesSubclinical reinfection contributes significantly to immunity against disease,significantly to immunity against disease, ascribed to vaccine or prior infection.ascribed to vaccine or prior infection.10/24/1610/24/16 2222DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  23. CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS Catarrhal Stage Paroxysmal Stage Convalescent Stage Due to long duration of the disease, Pertussis is also known as “100 day cough”.10/24/1610/24/16 2323DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  24. Catarrhal StageCatarrhal Stage 1.1. The stage lasts for 7-14The stage lasts for 7-14 days.days. 2.2. It is the most infectiousIt is the most infectious period.period. 3.3. Features:Features: 1.1. Low-grade fever.Low-grade fever. 2.2. Sneezing.Sneezing. 3.3. Lacrimation.Lacrimation. 4.4. Conjunctival suffusion.Conjunctival suffusion. 10/24/1610/24/16 2424DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  25. Catarrhal StageCatarrhal Stage 4.4. Cough:Cough: 1.1. Not paroxysmal in early stages, but moreNot paroxysmal in early stages, but more annoying and frequent at night.annoying and frequent at night. 2.2. Does not improve with passage of time,Does not improve with passage of time, unlike upper respiratory tract infections.unlike upper respiratory tract infections. 3.3. Paroxysmal nature of cough can beParoxysmal nature of cough can be suspected towards the later part of thissuspected towards the later part of this phase.phase.10/24/1610/24/16 2525DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  26. Paroxysmal PhaseParoxysmal Phase 1.1. This stage lasts for 2-4This stage lasts for 2-4 weeksweeks 2.2. Cough:Cough: 1.1. Initially dry, intermittent,Initially dry, intermittent, irritative hack.irritative hack. 2.2. Evolves into inexorableEvolves into inexorable paroxysms.paroxysms. 10/24/1610/24/16 2626DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  27. 3.3. The bout of cough terminates with alongThe bout of cough terminates with along drawn out inspiratory crowing sound ordrawn out inspiratory crowing sound or whoop.whoop. Paroxysmal PhaseParoxysmal Phase Cough is a forced expiratory effort against closed glottis. Hear cough, click here 10/24/1610/24/16 2727DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  28. WhoopWhoop The whoop is produced by the air rushingThe whoop is produced by the air rushing in during inspiration through the half openin during inspiration through the half open glottis.glottis. Hear whoop, click here 10/24/1610/24/16 2828DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  29. Paroxysmal PhaseParoxysmal Phase 4.4. The paroxysms of cough may occur everyThe paroxysms of cough may occur every hour, or even frequently, and mayhour, or even frequently, and may terminate by vomiting.terminate by vomiting. 10/24/1610/24/16 2929DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  30. 5.5. The child may appearThe child may appear chocked ,is unable tochocked ,is unable to breath, looks anxiousbreath, looks anxious and has suffused face.and has suffused face. Paroxysmal PhaseParoxysmal Phase 10/24/1610/24/16 3030DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  31. Paroxysmal PhaseParoxysmal Phase 6.6. The whoop may not always present inThe whoop may not always present in infants, who present with apneic orinfants, who present with apneic or cyanotic spells.cyanotic spells. 10/24/1610/24/16 3131DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  32. Infants <3 mo do not display classical stages. After the most insignificant startle from a draught, light, sound, sucking, or stretching, a well- appearing young infant begins to choke, gasp, and flail extremities, with face reddened. Cough (expiratory grunt) may not be prominent. 10/24/1610/24/16 3232DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  33. Whoop (forceful inspiratory gasp) infrequently occurs in infants <3 mo of age who are exhausted or lack muscular strength to create sudden negative intrathoracic pressure 10/24/1610/24/16 3333DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  34. A well-appearing, playful toddler with similarly insignificant provocation suddenly expresses an anxious aura and may clutch a parent or comforting adult before beginning a machine-gun burst of uninterrupted coughs, chin and chest held forward, tongue protruding maximally, eyes bulging and watering, face purple, until coughing ceases and a loud whoop follows as inspired air traverses the still partially closed airway.10/24/1610/24/16 3434DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  35. WhoopWhoop The whoop is produced by the air rushingThe whoop is produced by the air rushing in during inspiration through the half openin during inspiration through the half open glottis.glottis. Hear whoop, click here 10/24/1610/24/16 3535DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  36. Adults describe a sudden feeling of strangulation followed by uninterrupted coughs, feeling of suffocation, bursting headache, diminished awareness, and then a gasping breath, usually without a whoop 10/24/1610/24/16 3636DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  37. Convalescent PhaseConvalescent Phase 1.1. During convalescence, the interval betweenDuring convalescence, the interval between the paroxysms of cough increases andthe paroxysms of cough increases and severity of episode decreases gradually.severity of episode decreases gradually. 2.2. Paradoxically, in infants, coughs andParadoxically, in infants, coughs and whoop may become louder and morewhoop may become louder and more classic in convalescence.classic in convalescence. 10/24/1610/24/16 3737DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  38. Clinical Manifestations –Clinical Manifestations – Additional notesAdditional notes 1.1. Immunized childrenImmunized children have foreshortening ofhave foreshortening of all stages of pertussis.all stages of pertussis. 2.2. Adults have no distinctAdults have no distinct stages.stages. 10/24/1610/24/16 3838DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  39. Case definitionCase definition A suspected case of pertussis is defined as:A suspected case of pertussis is defined as: A person with aA person with a cough lasting at least two weekscough lasting at least two weeks with atwith at least one of the following:least one of the following:  Paroxysms (i.e. fits) of coughingParoxysms (i.e. fits) of coughing  Inspiratory whoopingInspiratory whooping  Post-tussive vomitingPost-tussive vomiting  Without other apparent causesWithout other apparent causes OROR Apnoea (with or without cyanosis)Apnoea (with or without cyanosis) in infants (age <1 year old)in infants (age <1 year old) with cough ofwith cough of any durationany duration OROR If aIf a specialist physician strongly suspectsspecialist physician strongly suspects pertussis in a patientpertussis in a patient with cough ofwith cough of any durationany duration..
  40. 3.3. In infants < 3months the catarrhal stageIn infants < 3months the catarrhal stage is usually a few days or not recognizedis usually a few days or not recognized at all when apnea chocking or gaspingat all when apnea chocking or gasping cough herald the onset of disease.cough herald the onset of disease. Clinical Manifestations –Clinical Manifestations – Additional notesAdditional notes 10/24/1610/24/16 4040DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  41. MCQsMCQs 1. Which of the following is not true about Pertussis – 1. The other name is “Whooping cough”. 2. The other name is “Hundred day cough”. 3. Everyone suffering from it must have whoop. 4. It is endemic with superimposed epidemic cycles every 2-3 years. Ans. – 3. 10/24/1610/24/16 4141DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  42. Diagnosis – ClinicalDiagnosis – Clinical 1.1. High suspicion index inHigh suspicion index in individual having pure orindividual having pure or predominant complaint ofpredominant complaint of cough f/b vomitting, andcough f/b vomitting, and Absent: 1. Fever. 2. Malaise / Myalgia. 3. Exanthem / Enanthem. 4. Sore throat, Hoarseness. 5. Tachypnoea. 6. Wheezes, Rales. 10/24/1610/24/16 4242DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  43. Diagnosis – ClinicalDiagnosis – Clinical 2.2. In infants < 3 monthsIn infants < 3 months of age, Apnea orof age, Apnea or Cyanosis (beforeCyanosis (before appreciation of cough)appreciation of cough) is the clue –is the clue – occasionally cause ofoccasionally cause of Sudden Infant Death.Sudden Infant Death. 10/24/1610/24/16 4343DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  44. 1.1. Leukocytosis – 15,000-Leukocytosis – 15,000- 100,000cells/mm100,000cells/mm33 .. 1.1. Absolute lymphocytosis.Absolute lymphocytosis. 2.2. Absolute increase in neutrophilsAbsolute increase in neutrophils suggests a differential diagnosis orsuggests a differential diagnosis or secondary bacterial infection.secondary bacterial infection. Diagnosis – Blood pictureDiagnosis – Blood picture 10/24/1610/24/16 4444DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  45. Laboratory diagnosisLaboratory diagnosis  Culture of nasopharyngeal secretionsCulture of nasopharyngeal secretions considered bestconsidered best  fastidious growth requirement s makes it difficult tofastidious growth requirement s makes it difficult to isolateisolate  chances of isolation maximum during catarrhalchances of isolation maximum during catarrhal phase and declines rapidly after two weeksphase and declines rapidly after two weeks  small window of opportunity for culture provensmall window of opportunity for culture proven diagnosisdiagnosis  PCRPCR  detects DNA sequence of the bacteriadetects DNA sequence of the bacteria  sensitivity decreases after 4 weeks of onsetsensitivity decreases after 4 weeks of onset  SerologySerology  useful for diagnosis inuseful for diagnosis in convalescent phaseconvalescent phase
  46. Diagnosis – Chest radiographDiagnosis – Chest radiograph 1.1. Only mildly abnormal –Only mildly abnormal – perihilar infiltrate or edemaperihilar infiltrate or edema (sometimes butterfly(sometimes butterfly appearance), and variableappearance), and variable atelectasis.atelectasis. 2.2. Parenchymal consolidationParenchymal consolidation suggests secondarysuggests secondary bacterial infection.bacterial infection. 3.3. Occasional Pneumothorax,Occasional Pneumothorax, Pneumomediastinum, andPneumomediastinum, and air in soft tissues.air in soft tissues. Pertussis pneumonia with hyperaeration (air trapping) 10/24/1610/24/16 4646DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  47. Diagnosis – Bacteriological testingDiagnosis – Bacteriological testing 1.1. Isolation ofIsolation of Bacillus pertussisBacillus pertussis is the goldis the gold standard in diagnosis.standard in diagnosis. 2.2. Positive in catarrhal and paroxysmalPositive in catarrhal and paroxysmal stage.stage. 10/24/1610/24/16 4747DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  48. Diagnosis – SerologyDiagnosis – Serology 1.1. Tests for detection of antibodies in acuteTests for detection of antibodies in acute and convalescent samples are mostand convalescent samples are most sensitive tests in immunised individuals.sensitive tests in immunised individuals. 2.2. Antibody to PT raised >2S.D. indicatesAntibody to PT raised >2S.D. indicates recent infection.recent infection. 3.3. Useful epidemiologically.Useful epidemiologically.10/24/1610/24/16 4848DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  49. Differential DiagnosisDifferential Diagnosis 1.1. Adenoviral infections –Adenoviral infections – distinguishable by presencedistinguishable by presence of fever, sore throat, andof fever, sore throat, and conjunctivitis.conjunctivitis. 2.2. Mycoplasma –Mycoplasma – distinguishable by history ofdistinguishable by history of fever, headache, & systemicfever, headache, & systemic symptoms; frequent rales onsymptoms; frequent rales on chest auscultation.chest auscultation. 10/24/1610/24/16 4949DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  50. Differential DiagnosisDifferential Diagnosis 3.3. Afebrile pneumoniaAfebrile pneumonia ((Chlamydia trachomatisChlamydia trachomatis) –) – distinguishable by staccatodistinguishable by staccato cough (i.e. breath with everycough (i.e. breath with every cough), purulent conjunctivitis,cough), purulent conjunctivitis, tachypnea, rales.tachypnea, rales. 4.4. Afebrile pneumonia (RSV) –Afebrile pneumonia (RSV) – distinguishable by lowerdistinguishable by lower respiratory tract signs.respiratory tract signs.10/24/1610/24/16 5050DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  51. MCQsMCQs 3. Which of the following is diagnostic of pertusis 1. Leucocytosis with absolute lymphocytosis. 2. Leucocytosis with relative lymphocytosis. 3. Leucocytosis with neutropenia. 4. Leucocytosis with eosinopenia. Ans. – 1. 10/24/1610/24/16 5151DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  52. ComplicationsComplications 1.1. Apnea.Apnea. 2.2. SecondarySecondary infections :infections : a.a. Otitis media.Otitis media. b.b. Pneumonia.Pneumonia. 3.3. Flaring up of existingFlaring up of existing TB infection.TB infection. 4.4. Malnutrition.Malnutrition. 10/24/1610/24/16 5252DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  53. Complications –Complications – PhysicalPhysical sequel of forceful coughingsequel of forceful coughing 1.1. Conjuctival andConjuctival and Scleral hemorrhage.Scleral hemorrhage. 2.2. Petechiae in upperPetechiae in upper body.body. 10/24/1610/24/16 5353DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  54. 3.3. Epistaxis.Epistaxis. 4.4. Hemorrhage inHemorrhage in CNS and Retina.CNS and Retina. Complications –Complications – PhysicalPhysical sequel of forceful coughingsequel of forceful coughing 10/24/1610/24/16 5454DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  55. 5.5. Pneunomothorax.Pneunomothorax. 6.6. Subcutaneous emphysema.Subcutaneous emphysema. 7.7. Umbilical and inguinalUmbilical and inguinal hernia.hernia. Complications –Complications – PhysicalPhysical sequel of forceful coughingsequel of forceful coughing 10/24/1610/24/16 5555DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  56. TreatmentTreatment 1.1. Antibiotics are useful only in the catarrhalAntibiotics are useful only in the catarrhal stage.stage. 2.2. Once the child goes in paroxysmal stage itOnce the child goes in paroxysmal stage it is very difficult to abort the very difficult to abort the attack. 10/24/1610/24/16 5656DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  57. TreatmentTreatment 1.1. Erythromycin 40-50 mg/kg/day in 4 dividedErythromycin 40-50 mg/kg/day in 4 divided doses X 14days. (Maximum 2 gm / 24doses X 14days. (Maximum 2 gm / 24 hrs.)hrs.) 2.2. Respiratory Isolation forRespiratory Isolation for ≥ 5 days after≥ 5 days after start of Erythromycin therapy.start of Erythromycin therapy.10/24/1610/24/16 5757DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  58. Alternative drugsAlternative drugs 1.1. Clarithromycin 15-20 mg/kg/day in 2 divClarithromycin 15-20 mg/kg/day in 2 div doses X 7 days. (Maximum 1 gm/24 hrs.)doses X 7 days. (Maximum 1 gm/24 hrs.) 2.2. Azithromycin 10 mg/kg/day once daily X 5Azithromycin 10 mg/kg/day once daily X 5 days.days. 10/24/1610/24/16 5858DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  59. Alternative drugsAlternative drugs 3.3. Ampicillin, Rifampicin and CotrimoxazoleAmpicillin, Rifampicin and Cotrimoxazole are modestly active against pertussis.are modestly active against pertussis. 4.4. The 1The 1stst and 2and 2ndnd generation Cephalosporinsgeneration Cephalosporins are not active against pertussis.are not active against pertussis. 10/24/1610/24/16 5959DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  60. Recommended treatment and post-exposureRecommended treatment and post-exposure prophylaxis, by age groupprophylaxis, by age group Age group Azithromycin Erythromycin Clarithromycin Alternate agent: TMP-SMX <1 month Recommended drug; 10 mg/kg per day in a single dose x 5 days 40–50 mg/kg per day in 4 divided doses x 14 days Not recommended. Contraindicated in infants <2 months of age 1–5 months 10 mg/kg per day in a single dose x 5 days. As above 15 mg/kg per day in 2 divided doses x 7 days. For infants aged >2 months of age, TMP 8 mg/kg per day; SMX 40 mg/kg per day in 2 divided doses x 14 days.
  61. Age group Azithromycin Erythromycin Clarithromyci n Alternate agent: TMP- SMX Children aged more than 6 months 10 mg/kg as a single dose on day 1 (maximum 500 mg); then 5 mg/kg per day as a single dose on days 2–5 (maximum 250 mg/day) 40 mg/kg per day in 4 divided doses for 7-14 days (maximum 1-2 g per day) Maximum 1g/day TMP 8 mg/kg per day; SMX 40 mg/kg per day in 2 divided doses x 14 days Adolescents and adults 500 mg as a single dose on day 1 then 250 mg as a single dose on days 2–5 2g/day in 4 divided doses x 14 days 1g/day in 2 divided doses x 7 days TMP 320 mg/day, SMX 1600mg/day in 2 divided doses x 14 RecommendedRecommended treatment and post-exposuretreatment and post-exposure ProphylaxisProphylaxis,,
  62. MCQsMCQs 2. The attack of pertussis can be aborted with the help of antibiotics only if the is treated : 1. In catarrhal stage. 2. In paroxysmal stage. 3. In convalescent stage. 4. In all the above stages. Ans. – 1. 10/24/1610/24/16 6262DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  63. MCQsMCQs 5. The drug of choice for the treatment of Pertusis & its dose is 1. Erythromycin 40-50 mg/kg/day 2. Cephalexin 50-100 mg/kg/day 3. Cotrimoxazole 5-8 mg/kg/day 4. Tetracyclin 20-40 mg/kg/day Ans. – 1. 10/24/1610/24/16 6363DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  64. Care of Household and CloseCare of Household and Close Contacts – ChemoprophylaxisContacts – Chemoprophylaxis Erythromycin 40-50Erythromycin 40-50 mg/kg/day in 4mg/kg/day in 4 divided doses X 14divided doses X 14 days regardless ofdays regardless of age, history ofage, history of immuinisation, andimmuinisation, and symptoms.symptoms. 10/24/1610/24/16 6464DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  65. Care of Household and CloseCare of Household and Close Contacts – ImmunisationContacts – Immunisation Situation for contact < 7 yearsSituation for contact < 7 years RecommendationRecommendation Not vaccinated against pertussisNot vaccinated against pertussis InitiateInitiate vaccinationvaccination Partially vaccinated againstPartially vaccinated against pertussispertussis Complete theComplete the recommendedrecommended scheduleschedule Received 3Received 3rdrd dose > 6 mths. backdose > 6 mths. back Booster doseBooster dose Received 4Received 4thth dosedose ≥ 3 years back≥ 3 years back Booster doseBooster dose 10/24/1610/24/16 6565DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  66. PREVENTIONPREVENTION V A C C I N E S Purified Acellular Vaccine Whole Cell Vaccine 10/24/1610/24/16 6666DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  67. Whole cell vaccine (DTP)Whole cell vaccine (DTP) 1. Developed in late 1940s. 2. Bacteria killed by heat or formalin. 3. Controversial because of local and systemic side effects: 1. Redness, Pain, Swelling. 2. Fever (30-70%). 10/24/1610/24/16 6767DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  68. Whole cell vaccine (DTP)Whole cell vaccine (DTP) 4. National Childhood Encephalopathy Study (Britain) : 1. Infantile Spasms. 2. Sudden Infant Death Syndrome (SIDS). 5. Efficacy : 1. Three doses. 2. 80 - 90% effective. 10/24/1610/24/16 6868DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  69. Purified acellular vaccinePurified acellular vaccine (DTaP)(DTaP) 1. Introduced in 1981 by Japan. 2. Contains subcomponents of bacteria: 1. Filamentous Hemagglutinin (Fha). 2. Pertussis Toxin (PT). 10/24/1610/24/16 6969DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  70. Purified acellular vaccine (DTaP)Purified acellular vaccine (DTaP) 3. Efficacy 1. Two doses. 2. 70% protection against culture confirmed infection. 3. 80% protection against severe whopping cough. 10/24/1610/24/16 7070DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  71. DTP VaccineDTP Vaccine 1. Content (BE ltd.): 1. Diptheria toxoid ≥20Lf to ≤30Lf. 2. Pertussis ≥4 IU. 3. Tetanus toxoid ≥5Lf to ≤25Lf. 2.2. Dose – 0.5 ml.Dose – 0.5 ml. 3.3. Route – DeepRoute – Deep intramuscular.intramuscular. 4.4. Recommended site –Recommended site – Antero-lateral part of thigh.Antero-lateral part of thigh. 10/24/1610/24/16 7171DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  72. Vaccination ScheduleVaccination Schedule 1. Immunization Policy : 1. 3 DPT doses during first year of life. 2. EPI recommendation 6, 10, 14 weeks. 2. Booster Policy : 1. 4th DPT vaccine at 12 to 24 months. 2. 5th DPT vaccine used by some countries (In India, given 3 years after 4th dose). 10/24/1610/24/16 7272DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  73. Contraindications to vaccinationContraindications to vaccination 1.1. Personal or strong family history ofPersonal or strong family history of epilepsy, convulsions or similar CNSepilepsy, convulsions or similar CNS disorders.disorders. 2.2. Any febrile upset until fully recovered.Any febrile upset until fully recovered. 3.3. Reaction to one of the previously givenReaction to one of the previously given triple vaccines.triple vaccines. 10/24/1610/24/16 7373DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  74. MCQsMCQs 4. What is the correct composition of DPT vaccine 1. D ≥40Lf; P ≥4 IU; T ≥5Lf to ≤25Lf. 2. D ≥20Lf to ≤30Lf; P ≥10 IU; T ≥5Lf to ≤25Lf. 3. D ≥20Lf to ≤30Lf; P ≥4 IU; T ≥5Lf to ≤25Lf. 4. D ≥20Lf to ≤30Lf; P ≥4 IU; T ≤25Lf. Ans. – 3. 10/24/1610/24/16 7474DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  75. Diphtheria toxoid; Tetanus toxoid; Pertussis vaccine; Diphtheria toxoid 25 Lf, tetanus toxoid 10 Lf, purified Bordetella pertussis antigens (pertussis toxoid 25 mcg, filamentous haemagglutinin 25 mcg, 69 kDA outer membrane protein 8 mcg) per 0.5 mL; aluminium hydroxide (adsorbant), 10/24/1610/24/16 7575DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  76. Dose: 0.5 mL IMI. Primary course: 3 doses at 2, 4 and 6 months, then 4th dose at 18 months, 5th dose at 4-5 years 10/24/1610/24/16 7676DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (
  77. 2 TYPES OF VACCINES2 TYPES OF VACCINES 1. Tdap Combination Vaccine for Diphtheria, Pertussis & Tetanus For all ages 11 years or more For pregnant Women also
  79. Vaccination In PregnancyVaccination In Pregnancy  IAP recommends thatIAP recommends that pregnant women receive thepregnant women receive the whooping cough vaccine forwhooping cough vaccine for adolescents and adultsadolescents and adults (called Tdap vaccine) during(called Tdap vaccine) during the third trimester of eachthe third trimester of each pregnancy.pregnancy.
  80. Why vaccinate in pregnancyWhy vaccinate in pregnancy only??only??
  81. Few other facts…Few other facts…  Vaccinate mother in third trimester of pregnancyVaccinate mother in third trimester of pregnancy  Vaccinate mother each time she is pregnantVaccinate mother each time she is pregnant  Breast feeding can transfer antibodies to infantBreast feeding can transfer antibodies to infant  Blood tests wont tell about the antibody titre inBlood tests wont tell about the antibody titre in bloodblood
  82. ConclusionsConclusions 1.1. Pertussis is a vaccine preventablePertussis is a vaccine preventable disease caused bydisease caused by Bacillus pertussis.Bacillus pertussis. 2.2. It is characterised by intensive coughIt is characterised by intensive cough and whoop, and absence of otherand whoop, and absence of other systemic features.systemic features. 3.3. Highly contagious disease – prophylaxisHighly contagious disease – prophylaxis of all contacts recommended.of all contacts recommended. 10/24/1610/24/16 8282DR HARIVANSH CHOPRADR HARIVANSH CHOPRA (

Hinweis der Redaktion

  1. Whooping cough vaccination during pregnancy is ideal so that baby will have short-term protection as soon as he is born. This early protection is important because baby will not start getting his whooping cough vaccines until he is 2 months old. These first few months of life are when baby is at greatest risk for catching whooping cough and having severe, potentially life-threating complications from the infection. To avoid that gap in protection, it is best to get a whooping cough vaccine during pregnancy so to pass protection to baby before he is born. To continue protecting your baby, he should get whooping cough vaccines starting at 2 months old.