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Whooping cough (pertussis)

What is whooping cough?

Whooping cough is a disease caused by the Bordetella pertussis bacterium that, if left untreated, can last for several weeks. Characteristic are convulsive coughing attacks, so-called "staccato coughs", which occur at certain intervals. The patients cough violently and intermittently and seem to almost suffocate in the process. After every cough attack, they breathe in again with a typical wheezing, pulling noise. Vomiting often occurs as part of the coughing attacks. Whooping cough infection can cause more serious complications, especially in young children. Newborns and infants are particularly at risk, as they can sometimes suffer fatal respiratory arrests. Around 1900 whooping cough was one of the most common causes of death in children in the German Empire, along with diphtheria, scarlet fever and measles. Adults can also get whooping cough. This happens far more often than previously thought.

causes

The whooping cough pathogen Bordetella pertussis was named after one of its discoverers, the Belgian bacteriologist Jules Bordet (1870-1961). Whooping cough is highly contagious, especially in the early stages of the disease, before the typical cough breaks out. The pathogen is transmitted from person to person via droplet infection, for example via the air we breathe. Then the bacteria settle in the upper airways, windpipe and bronchi. Here they multiply and form toxins that damage the mucous membranes and cilia and trigger inflammatory processes. In addition, they irritate the cough center in the brain and thus cause the characteristic coughing attacks.

Anyone who has not acquired immunity or has not been vaccinated and comes into contact with a sick person has a 70 to 80 percent risk of becoming infected. After surviving whooping cough, those affected are immune for about ten years. They can then become infected again, often without noticing it, as the disease is often milder. Despite a vaccination in childhood, the disease can occur later, as the vaccination protection wears off after five to fifteen years. Young people and adults in particular are therefore dangerous vectors for infants and unvaccinated children.

Symptoms

About seven to 20 days (incubation period) after a child is infected, the first, as yet atypical, symptoms appear. This makes the disease contagious and will remain without treatment for the next few weeks. The excruciating cough then follows in the second of three disease stages that are characteristic of an initial illness:

1) stage catarrhale: This initial phase usually lasts one to two weeks. As with a cold, the child has a runny nose, sometimes a slightly elevated temperature, coughs a little and feels tired and exhausted.

2) convulsive stage: In the second phase, which can last four to six weeks, the fever usually subsides again, but it starts with violent, often nocturnal coughing attacks. The convulsive coughing attacks are also known as staccato coughing. The sick cough in several dry puffs and almost threaten to suffocate. Your face turns red to bluish. Then they breathe in, panting and whistling (hence whooping cough). Further series of coughs can follow one after the other. At the end of an attack, those affected choke thick mucus, and sometimes they have to vomit. Then there is a longer pause without coughing. Many such coughing fits can occur within a day and night. Sore muscles, stomach aches and headaches are possible side effects.

3) stage decrementi: In the last two to four weeks, in the third stage of the disease, the coughing attacks gradually become less frequent and weaker. If left untreated, the decrementi stage can drag on for four to six weeks.

Babies are most at risk. They often do not have the typical coughing attacks, but just beep helplessly. Your airways, which are still narrow, can swell quickly. In addition, when coughing, they cannot sit up on their own and put them in a better position. This leads to attacks of suffocation and life-threatening pauses in breathing (apnea), which can be exacerbated by life-threatening involvement of the central nervous system (encephalopathy). For this reason, babies should always be examined by a doctor, even if they have symptoms that might only suggest a harmless cold.

The characteristic staccato cough is also often absent in adults. The disease is more like bronchitis. In adults with a long-lasting or chronic cough, whooping cough should therefore always be considered.

Complications

In the first few years of life, whooping cough disease can often cause pneumonia and otitis media due to an additional infection with other pathogens. In individual cases, whooping cough leads to seizures with an oxygen deficiency in the brain. The poisons of the whooping cough bacteria can also permanently damage the brain (encephalopathy). Such complications are particularly threatening for infants. As a result, there is a risk of respiratory arrest for them.

The violent cough sometimes leads to nosebleeds, tongue ligament ulcers, bleeding in the conjunctiva or, in extreme cases, inguinal and rib hernias. Long-term consequences of whooping cough toxins can also be allergic diseases and chronic asthma.

diagnosis

The easiest way for the doctor to diagnose whooping cough in children is based on the characteristic coughing fits. Adults in whom the disease is milder should already be alarmed when they have a dry cough that does not go away.

A proof of the pathogen is possible in the early stages of an initial illness. However, bacterial cultures from the nasopharyngeal secretions are only successful in every second patient. A faster and more reliable diagnosis is now possible through the PCR (Polymerase Chain Reaction = polymerase chain reaction). This enables the genetic material of pathogens to be detected in the nasopharyngeal secretion even before antibodies are formed. Because with the PCR, tiny amounts of genetic information (deoxyribonucleic acid, DNA) can be reproduced billions of times within a few hours. It is one of the most sensitive methods of infection diagnosis.

Specific antibodies against the bacterium do not show up in the blood serum until two to four weeks after infection.

In addition, the doctor will clarify whether there are any possible complications, such as pneumonia or otitis media.

therapy

An antibiotic (for example erythromycin, azithromycin and clarithromycin) used by the doctor at the beginning of the disease can kill the bacteria, have a beneficial effect on the course and reduce the risk of infection. It is taken over 14 days. Nevertheless, the coughing fits continue. And so long until the cilia of the bronchi have recovered and the toxin of the pathogen has broken down. So patience is an important requirement for recovery.

Since sick people can still be contagious five to seven days after starting therapy, they should stay at home during this time. But even afterwards it is often exhausting for them to go to kindergarten, school or work with a cough, even if they are no longer contagious. Parents of sick children or sick adults are best advised to discuss this with their doctor.

Infants should always be treated in a hospital. This is the only place where you can alleviate shortness of breath, suck out mucus and prevent the risk of suffocation and ward off further infections in good time.

A child plagued by whooping cough needs a lot of attention. During attacks, it helps if parents or caregivers calm it down, carry it around, or sit it on. Fresh air is also good. After the coughing fit, the sick child should drink a lot and be given light meals. Walks and quiet play are distracting.

Any physical exertion, even a hearty laugh, is less beneficial because this type of exertion can trigger another violent coughing attack. In older children, regular inhalations over a bowl of hot water and a few teaspoons of sea salt can help relieve discomfort. However, this method is not suitable for small children because of the risk of scalding. In the pharmacy, however, you can borrow a medical inhalation device: The water droplets are swirled more finely and penetrate deeper into the bronchi than with the "bowl method".

Caregivers who have not yet been vaccinated against whooping cough should be given the same antibiotic as the sick child if they have close contact. It does not make sense to vaccinate in the time between infection and the onset of whooping cough (incubation period).

Vaccination against whooping cough

The whooping cough vaccination had a bad reputation for a long time. Because it was not clear which components of the pathogen are responsible for the protective immunity. Therefore, doctors administered a killed whole-cell preparation. This protected, but sometimes caused severe side effects. The vaccine, which has been available for around 20 years, only consists of precisely defined cell components that are necessary for the development of disease protection. The side effects have thus become minor.

Basic immunization begins with babies from the age of two months. It consists of four vaccinations. There is currently no single vaccine for whooping cough. The whooping cough vaccination is combined with other vaccinations, for example immunization against tetanus, diphtheria and polio. The STIKO (Standing Vaccination Commission) has been recommending a first booster vaccination at the age of five to six since 2006, also as a combination vaccination with diphtheria and tetanus. An additional booster vaccination is given from the age of 9 to 17. The vaccination protection lasts ten to 15 years. Then infection is possible again despite an earlier vaccination. All adults should be vaccinated against whooping cough once during the next re-vaccination against tetanus and diphtheria.

An important goal is to exclude sources of infection for newborns and small babies. Before birth