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Whooping cough
- 1. PERTUSSIS or WHOOPINGCOUGH Presented by – Mohamed Akmal Khan MBBS ( VII SEM) IIMS&R ,LUCKNOW
- 2. INDEX INTRODUCTION EPIDEMIOLOGICALDETERMINANTS INCUBATION PEROID CLINICAL COURSE COMPLICATIONS TREATMENT AND CONTROL
- 3. INTRODUCTION Pertussis isalso called as Whooping cough is a highly contagious disease mainly of children caused by Bordetella pertussis. It is characterized by severe uncontrollable coughing spells which can sometimes end in a “whoop” sound when person breathes in. Also called as “100 day cough” by Chinese.
- 4. In 2012,2.49 cases were reported by WHO globally when the DPT immunization was 83%. In India after launch of immunization programme in 1987, the reported cases dropped from 1.63 lakh to only 36,661 cases in 2013 ( 77% decline) Underlying malnutrition and other respiratory infections in children make then prone to this disease. Recently the disease shows increase incidence in older children, adolescents and adults.(21% adults had pertussis after serological studies of adults with cough for more than 2 weeks)
- 5. Epidemiological Determinants AGENTFACTORS- Agent -Causative agent is Bordetella pertussis. Also caused by B.parapertussis, Viruses(parainfluenzae, adenovirus)
- 6. Source ofinfection- Only man is the known source of infection. Pervious case of pertussis which may be mild, missed and unrecognised case is usually the source of infection. No chronic carrier state exist Infective material –Nasopharyngeal and bronchial secretion. Fomites contaminated by such discharge are also infective.
- 7. Infective period-Catarrhal stage most infective. Extends from week after exposure to about 3 weeks after onset of paroxysmal stage. Secondary attack rate- Average 90% in unimmunized people.
- 8. HOST FACTORS Age-Infants and pre-school (<5 years) - Developing countries (20-30 months) and developed countries (50 months) -Highest mortality below 6 months. Sex- More common among females. Immunity-Immunity develops after a case or immunization. No cross immunity. Secondary attack occur in declining immune person.
- 9. ENVIRONMENT More casesoccur during winter and spring. Lower socio-economic group more prone than well to do groups due to overcrowding.
- 10. INCUBATION PEROID Usually7-14 days but not more than 3 weeks
- 11. CLINICAL COURSE Causeslocal infection by multiplying in the surface epithelium of respiratory mucosa. Leads to inflammation and necrosis of mucosa. Occurs in 3 stages- 1. Catarrhal stage 2. Paroxysmal stage 3. Convalescent stage
- 12. 1. Catarrhalstage- - Lasts for 10 days. - Characterized by: Insidious onset Lacrimation Sneezing Coryza Anorexia Malaise Hacking night cough that becomes diurnal
- 13. 2. Paroxysmalstage -Lasts for 2-4 weeks -Characterized by burst of rapid, consecutive coughs followed by a deep, deep pitched inspiration (whoop) - Followed by vomiting In infants- Causes cyanosis and apnoea In adults and adolescents- Uncharacteristic,persistent cough
- 14. 3. Convalescentstage- Lasts for 1-2 weeks Decrease in paroxysms of coughing both in freq and severity Cessation of Vomiting
- 15. Complications Occurs in5-6% cases Frequent in infants aged less than 6 months Mainly- Bronchitis - Bronchopneumonia (5.2%) -Bronchiectasis -Subconjuctival hemorrhage -Epistaxis -Heomptysis -Punctate cerebral hemorrhage -Coma and convulsions
- 16. Control of whoopingcough Cases and contacts- 1. Cases- Early diagnosis by bacteriological exam. of nose and throat secretions (60% chances within 10-14 days from onset) - Isolation of case - Treatment of case- Erythromycin 30-50 mg/kg for 10 days Septran , Ampicillin and Tetracycline can also be used. Given during incubation or in early catarrhal stage to prevent or moderate clinical pertussis. During paroxysmal stage only eliminate bacteria from nasopharynx eliminating transmission
- 17. 2.Contacts -Isolation of case -Prophylacticantibiotics (Erythromycin or Ampicillin ) treatment for 10 days to prevent establishment of case in exposed infants.
- 18. Active immunization -Covered under National Immunization Programme -Combined as DPT, DTWP or DTaP vaccine. -Administered as 3 dose ( each dose 0.5 ml) IM at 1 month interval starting at 6 weeks. -Booster dose at 18-24 months -Acellular vaccine for older children and adults
- 19. Efficacy 85% Duration of protection 6-12 years following complete dose+ booster HIV positive individuals should also be immunized Adverse reactions- Early vaccine caused screaming and collapse. -Give rise to local reactions at site of injection, mild fever and irritability -Rare vaccine reaction are- Inconsolable screaming, seizures, hypotonic hypo- responsive episode,
- 20. Contraindications- Anaphylactic reactions, encephalopathy,history of epilepsy, convulsions or similar CNS disorders , any febrile episode and reaction to previous triple vaccine • Passive immunization- Hyperimmune globulin is given but efficacy no established yet.
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