We have been vaccinating children against whooping cough for so long that we even started to think that maybe we don’t need it anymore? But three years ago, an outbreak in Vilnius district denied these hopes. So yes, vaccination was necessary, necessary and necessary – and not only for children.
The only source of pertussis infection is humans. The infection spreads through air droplets, it is contracted from a sick person or a carrier of the pathogen. When the patient talks, sneezes, coughs, the causative agent enters the environment with saliva droplets for about 6 weeks, penetrates the mucous membrane of the upper respiratory tract of a healthy person, where it multiplies and causes inflammation. At the beginning, these insidious diseases of babies are indistinguishable from a simple cold: a slightly elevated temperature, a weak cough… As the disease takes hold, the symptoms intensify, and the cough becomes paroxysmal, which can last from several to ten minutes. Seizures often end in vomiting. The disease is only partially cured with antibiotics, which help prevent further spread of the disease, but do not relieve the symptoms or shorten the duration of the disease in a person who is already sick. In addition, treatment is most effective when started early in the course of the disease, within the first two weeks, before severe, continuous coughing attacks. After severe long-term coughing fits, breathing may stop due to hypoxia of the brain and overstimulation of the respiratory centers. In extremely severe forms of whooping cough, brain damage is possible, leading to long-term neurological sequelae and even death. Whooping cough is especially difficult for babies. They are much more likely to have complications such as hernia, pneumonia or encephalopathy.
Mortality is minimal
“It’s actually an unpleasant disease, coughing attacks are really tiring for a child – agrees Santara Clinic’s pediatric pulmonologist doc. Dr. Sigita Petraitiene. – The problem is that the child can cough for several weeks during those coughing attacks, called reruns. Such a cough from a minor irritant can recur even for about six months. Hypoxic encephalopathy is described in the literature as one of the complications of whooping cough. Such children may have behavioral and learning disorders in the future. Of course, if the necessary medical assistance is provided in time, most likely already in the intensive care unit (“resuscitation”), such complications rarely occur nowadays.”
In the most severe case of the disease, according to the doctor, respiratory failure may develop, which in turn may lead to resuscitation and artificial lung ventilation. The mortality rate is almost zero, but… “About ten years ago, we had a case when a child could not be saved,” S.Petraitienė sighs sadly, “but he had, in addition to whooping cough itself, other concomitant health disorders and health disorders due to improper nutrition.” And a little secret: just to prevent moderate and severe cases of the disease, children are vaccinated against whooping cough.
It also saves adults
“The vaccine does not eliminate asymptomatic carriage in the nasopharynx completely,” the pulmonologist points out. – It covers more precisely the prevalence of severe and moderate diseases. Vaccinated people also carry whooping cough for a shorter period of time and spread it less, and are less contagious.” This is precisely the main reason for vaccinating children: although the circulation of whooping cough in our society has decreased significantly at the moment, it still circulates. “The bottom line is that the vaccine works for about ten years,” reminds S.Petraitienė. – This is precisely why a vaccine has already been developed for adults. When we vaccinate small, two, four or six-month-old children, then one-year-old and six-year-olds – with one vaccination against six diseases, then 15-16-year-old teenagers should be vaccinated again. And then we already recommend that adults renew their immunity approximately every ten years.” According to the doctor, young children get sick a little differently when they encounter whooping cough for the first time than teenagers who were vaccinated in childhood before starting school. “For teenagers, it’s not as terrible a disease as it is for little ones, it’s just a prolonged, tiring, nasty, dry non-productive cough,” she says. – Such tracheitis lasting a month or more. And here it is proven that the cause of that cough is the same whooping cough! So about ten years ago, it was decided to vaccinate teenagers as well. And adults.” Adults, especially young people who have babies and young children themselves, have a slightly higher risk of bringing the infection into the family. “Babies start being vaccinated only from the age of two months,” reminds S.Petraitienė. – Let’s give another two months for the immunity to build up properly… so we get that the baby is not yet properly protected for about four months after birth.” And it is babies from birth to 3-4 months who are most seriously ill with whooping cough, they usually have complications (not only pneumonia or hernia (due to increased pressure in the abdominal cavity when coughing), but also convulsions and the already mentioned irreversible brain damage due to lack of oxygen during active coughing with respiratory arrest. Adults, being asymptomatic carriers and not even knowing it, can accidentally infect their children. It is the people in the close environment who are the source of infection of whooping cough in babies, so the best way to adequately protect a newborn from whooping cough is to first vaccinate the mother against this disease. It is recommended to vaccinate future mothers during the third trimester of pregnancy. In adults, whooping cough itself, apart from a troublesome cough, usually does not cause more serious health ailments. Many people do not even know that they are sick with it, because even if the cough is not treated, it subsides on its own with time.
Not yet in our generation
Will we be able to completely get rid of whooping cough, as we got rid of, say, trachoma, which has not been recorded in Lithuania since 1962? I hear doubt in the doctor’s voice. “Well, maybe someday,” she continues. – When we are no longer there… Our society is not so united that for a decade we would all vaccinate close to one hundred percent against whooping cough. And so must the people of the whole world… For now, whooping cough is still a problem, and it will certainly be for many more decades, so vaccination is worth it. It’s worth vaccinating both children and ourselves.” So we agree that maybe not in our lifetime. Maybe in the time of our children or their children, but whooping cough will also be defeated, just as smallpox, leprosy, anthrax, tetanus, rabies, spotted typhus and similar exotics were banished from our sky by means of hygiene or vaccination. Until then, vaccination every ten years, and let’s not cough.
The latest outbreak of whooping cough
According to the Center for Communicable Diseases and AIDS (ULAC), in 2020 in the first quarter, 55 cases of whooping cough were registered in Lithuania – twice as many as in all of 2019. Most of these people – as many as 29 – were unvaccinated. These are all sick babies and children under the age of four. Some adults had unknown vaccination status or an unknown number of vaccination doses. Approximately one-fifth of the sick were children aged 5-9 and 10-14, as well as adults over 30 years old, about four percent of sick people were also in the 15-19 age group, and no illnesses were registered in the 20-29 age group. At most – as much as 83.6 percent. – registered cases of illness in Vilnius county.
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