pertussis (whooping cough) dr. harivansh chopra, dch, md professor, professor, department of...
TRANSCRIPT
Pertussis Pertussis (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. [email protected]@gmail.com
ObjectivesObjectives
1.1. To study the epidemiology of Pertussis.To study the epidemiology of Pertussis.
2.2. To study prevention and treatment of To study prevention and treatment of Pertussis.Pertussis.
04/21/2304/21/23 22DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
PertussisPertussis
1.1. Syadenham first Syadenham first used the term used the term “Pertussis”“Pertussis” (intense (intense cough) in1960.cough) in1960.
2.2. It is preferable to the It is preferable to the term term “whooping “whooping cough”cough” since most since most infected individuals infected individuals do not whoop. do not whoop.
04/21/2304/21/23 33DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
EPIDEMIOLOGYEPIDEMIOLOGY
1.1. Worldwide Worldwide distribution.distribution.
2.2. Global burden in Global burden in terms of DALYs lost terms of DALYs lost was 12.95 million in was 12.95 million in 2002, and 2.95 lakh 2002, and 2.95 lakh died during the same died during the same year.year.
04/21/2304/21/23 44DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
EPIDEMIOLOGYEPIDEMIOLOGY
3.3. Pertussis is endemic with epidemic Pertussis is endemic with epidemic cycles every 2 – 3 years after cycles every 2 – 3 years after accumulation of susceptible cohorts.accumulation of susceptible cohorts.
04/21/2304/21/23 55DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
India – Decline of PertussisIndia – Decline of Pertussis
1,63,000
26,700
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
Per
tuss
is C
ases
1987 2000
83.7%
04/21/2304/21/23 66DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
EPIDEMIOLOGYEPIDEMIOLOGY
4.4. Majority of cases Majority of cases occur from July occur from July through October.through October.
04/21/2304/21/23 77DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
EPIDEMIOLOGYEPIDEMIOLOGY
5.5. Extremely contagious, Extremely contagious, with attack rate as high with attack rate as high as 100% in susceptible as 100% in susceptible individuals exposed to individuals exposed to aerosol droplets at aerosol droplets at close range. close range.
04/21/2304/21/23 88DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
EPIDEMIOLOGYEPIDEMIOLOGY
6.6. Sub clinical Sub clinical infection is 50% in infection is 50% in fully immunized fully immunized and naturally and naturally immune individual.immune individual.
04/21/2304/21/23 99DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Agent FactorAgent Factor
1.1. Agent is Agent is Bacillus Bacillus pertussispertussis in majority of in majority of cases.cases.
2.2. In 5% cases In 5% cases Bacillus Bacillus parapertussisparapertussis..
3.3. Bacillus pertussisBacillus pertussis does does not survives for prolonged not survives for prolonged periods in the periods in the environmentenvironment
04/21/2304/21/23 1010DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
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 not Chronic carriage by humans is not documented.documented.04/21/2304/21/23 1111DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Infective MaterialInfective Material
1.1. Nasopharyngeal and Nasopharyngeal and bronchial secretions – bronchial secretions – Droplet infection and Droplet infection and Direct contact.Direct contact.
2.2. Freshly contaminated Freshly contaminated fomites.fomites.
04/21/2304/21/23 1212DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Infective PeriodInfective Period
A week after A week after exposure to about exposure to about 3 weeks after the 3 weeks after the onset of the onset of the paroxysmal stage.paroxysmal stage.
Secondary Attack rate is 90%.
04/21/2304/21/23 1313DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Incubation PeriodIncubation Period
Ranges from 7 – 14 Ranges from 7 – 14 days.days.
04/21/2304/21/23 1414DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Host Factor – Age Host Factor – Age
1.1. Primarily a disease of infants and pre-Primarily a disease of infants and pre-school children. school children.
2.2. Higher incidence found below five years Higher incidence found below five years of age.of age.
04/21/2304/21/23 1515DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Host Factor – Age Host 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.
4.4. Infants < 6 months of age have highest mortality.Infants < 6 months of age have highest mortality.
04/21/2304/21/23 1616DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Female children show higher incidence Female children show higher incidence and mortality.and mortality.
Host Factor – SexHost Factor – Sex
04/21/2304/21/23 1717DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Host Factors - ImmunityHost Factors - Immunity
1.1. Infants are susceptible Infants are susceptible to infection from birth to infection from birth because there is no because there is no protection from maternal protection from maternal antibodies.antibodies.
2.2. Recovery from Pertussis Recovery from Pertussis and Adequate and Adequate Immunisation both lead Immunisation both lead to immunity.to immunity.
04/21/2304/21/23 1818DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Host Factors - ImmunityHost Factors - Immunity
3.3. Neither natural disease nor vaccination Neither natural disease nor vaccination provides complete or lifelong immunity provides complete or lifelong immunity against reinfection or disease.against reinfection or disease.
4.4. Protection begins to wane 3 – 5 yrs after Protection begins to wane 3 – 5 yrs after vaccination; unmeasurable after 12 yrs.vaccination; unmeasurable after 12 yrs.
5.5. Subclinical reinfection contributes Subclinical reinfection contributes significantly to immunity against disease, significantly to immunity against disease, ascribed to vaccine or prior infection.ascribed to vaccine or prior infection.04/21/2304/21/23 1919DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS
Catarrhal Stage
Paroxysmal Stage
Convalescent Stage
Due to long duration of the disease,Pertussis is also known as “100 day cough”.
04/21/2304/21/23 2020DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Catarrhal StageCatarrhal Stage
1.1. The stage lasts for 7-14 The stage lasts for 7-14 days.days.
2.2. It is the most infectious It 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.
04/21/2304/21/23 2121DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Catarrhal StageCatarrhal Stage
4.4. Cough:Cough:
1.1. Not paroxysmal in early stages, but more Not 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 be Paroxysmal nature of cough can be suspected towards the later part of this suspected towards the later part of this phase.phase.04/21/2304/21/23 2222DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Paroxysmal PhaseParoxysmal Phase
1.1. This stage lasts for 2-4 This stage lasts for 2-4 weeks weeks
2.2. Cough:Cough:
1.1. Initially dry, intermittent, Initially dry, intermittent, irritative hack.irritative hack.
2.2. Evolves into inexorable Evolves into inexorable paroxysms.paroxysms.
04/21/2304/21/23 2323DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
3.3. The bout of cough terminates with along The bout of cough terminates with along drawn out inspiratory crowing sound or drawn out inspiratory crowing sound or whoop.whoop.
Paroxysmal PhaseParoxysmal Phase
Cough is a forced expiratory effort against closed glottis.
Hear cough, click here04/21/2304/21/23 2424DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
WhoopWhoopThe whoop is produced by the air rushing The whoop is produced by the air rushing in during inspiration through the half open in during inspiration through the half open glottis.glottis.
Hear whoop, click here04/21/2304/21/23 2525DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Paroxysmal PhaseParoxysmal Phase
4.4. The paroxysms of cough may occur every The paroxysms of cough may occur every hour, or even frequently, and may hour, or even frequently, and may terminate by vomiting.terminate by vomiting.
04/21/2304/21/23 2626DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
5.5. The child may appear The child may appear chocked ,is unable to chocked ,is unable to breath, looks anxious breath, looks anxious and has suffused face.and has suffused face.
Paroxysmal PhaseParoxysmal Phase
04/21/2304/21/23 2727DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Paroxysmal PhaseParoxysmal Phase
6.6. The whoop may not always present in The whoop may not always present in infants, who present with apneic or infants, who present with apneic or cyanotic spells.cyanotic spells.
04/21/2304/21/23 2828DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
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.
04/21/2304/21/23 2929DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
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
04/21/2304/21/23 3030DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
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.
04/21/2304/21/23 3131DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
WhoopWhoopThe whoop is produced by the air rushing The whoop is produced by the air rushing in during inspiration through the half open in during inspiration through the half open glottis.glottis.
Hear whoop, click here04/21/2304/21/23 3232DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
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
04/21/2304/21/23 3333DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Convalescent PhaseConvalescent Phase
1.1. During convalescence, the interval between During convalescence, the interval between the paroxysms of cough increases and the paroxysms of cough increases and severity of episode decreases gradually.severity of episode decreases gradually.
2.2. Paradoxically, in infants, coughs and Paradoxically, in infants, coughs and whoop may become louder and more whoop may become louder and more classic in convalescence. classic in convalescence.
04/21/2304/21/23 3434DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Clinical Manifestations – Clinical Manifestations – Additional notesAdditional notes
1.1. Immunized children Immunized children have foreshortening of have foreshortening of all stages of pertussis.all stages of pertussis.
2.2. Adults have no distinct Adults have no distinct stages.stages.
04/21/2304/21/23 3535DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
3.3. In infants < 3months the catarrhal stage In infants < 3months the catarrhal stage is usually a few days or not recognized at is usually a few days or not recognized at all when apnea chocking or gasping 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
04/21/2304/21/23 3636DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
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. – 3.04/21/2304/21/23 3737DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Diagnosis – ClinicalDiagnosis – Clinical1.1. High suspicion index in High suspicion index in
individual having pure or individual having pure or predominant complaint of cough predominant complaint of cough f/b vomitting, and f/b vomitting, and Absent:
1. Fever.2. Malaise / Myalgia.3. Exanthem / Enanthem.4. Sore throat, Hoarseness.5. Tachypnoea.6. Wheezes, Rales.
04/21/2304/21/23 3838DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Diagnosis – ClinicalDiagnosis – Clinical
2.2. In infants < 3 months In infants < 3 months of age, Apnea or of age, Apnea or Cyanosis (before Cyanosis (before appreciation of cough) appreciation of cough) is the clue – is the clue – occasionally cause of occasionally cause of Sudden Infant Death.Sudden Infant Death.
04/21/2304/21/23 3939DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
1.1. Leukocytosis – Leukocytosis – 15,000-100,000cells/mm15,000-100,000cells/mm33..
1.1. Absolute lymphocytosis.Absolute lymphocytosis.
2.2. Absolute increase in neutrophils Absolute increase in neutrophils suggests a differential diagnosis or suggests a differential diagnosis or secondary bacterial infection. secondary bacterial infection.
Diagnosis – Blood pictureDiagnosis – Blood picture
04/21/2304/21/23 4040DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Diagnosis – Chest radiographDiagnosis – Chest radiograph
1.1. Only mildly abnormal – Only mildly abnormal – perihilar infiltrate or edema perihilar infiltrate or edema (sometimes butterfly (sometimes butterfly appearance), and variable appearance), and variable atelectasis.atelectasis.
2.2. Parenchymal consolidation Parenchymal consolidation suggests secondary bacterial suggests secondary bacterial infection.infection.
3.3. Occasional Pneumothorax, Occasional Pneumothorax, Pneumomediastinum, and air Pneumomediastinum, and air in soft tissues.in soft tissues.
Pertussis pneumonia with hyperaeration (air trapping)
04/21/2304/21/23 4141DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Diagnosis – Bacteriological testingDiagnosis – Bacteriological testing
1.1. Isolation of Isolation of Bacillus pertussisBacillus pertussis is the gold is the gold standard in diagnosis.standard in diagnosis.
2.2. Positive in catarrhal and paroxysmal Positive in catarrhal and paroxysmal stage.stage.
04/21/2304/21/23 4242DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Diagnosis – SerologyDiagnosis – Serology
1.1. Tests for detection of antibodies in acute Tests for detection of antibodies in acute and convalescent samples are most and convalescent samples are most sensitive tests in immunised individuals.sensitive tests in immunised individuals.
2.2. Antibody to PT raised >2S.D. indicates Antibody to PT raised >2S.D. indicates recent infection.recent infection.
3.3. Useful epidemiologically.Useful epidemiologically.04/21/2304/21/23 4343DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Differential DiagnosisDifferential Diagnosis
1.1. Adenoviral infections – Adenoviral infections – distinguishable by presence distinguishable by presence of fever, sore throat, and of fever, sore throat, and conjunctivitis.conjunctivitis.
2.2. Mycoplasma – Mycoplasma – distinguishable by history of distinguishable by history of fever, headache, & systemic fever, headache, & systemic symptoms; frequent rales on symptoms; frequent rales on chest auscultation.chest auscultation.
04/21/2304/21/23 4444DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Differential DiagnosisDifferential Diagnosis
3.3. Afebrile pneumonia Afebrile pneumonia ((Chlamydia trachomatisChlamydia trachomatis) – ) – distinguishable by staccato distinguishable by staccato cough (i.e. breath with every cough (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 lower distinguishable by lower respiratory tract signs.respiratory tract signs.
04/21/2304/21/23 4545DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
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. – 1.04/21/2304/21/23 4646DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
ComplicationsComplications
1.1. Apnea.Apnea.
2.2. Secondary infections :Secondary infections :
a.a. Otitis media.Otitis media.
b.b. Pneumonia.Pneumonia.
3.3. Flaring up of existing Flaring up of existing TB infection.TB infection.
4.4. Malnutrition.Malnutrition.
04/21/2304/21/23 4747DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Complications – Complications – Physical Physical sequel of forceful coughingsequel of forceful coughing
1.1. Conjuctival and Conjuctival and Scleral hemorrhage.Scleral hemorrhage.
2.2. Petechiae in upper Petechiae in upper body.body.
1.1. Conjuctival and Conjuctival and Scleral hemorrhage.Scleral hemorrhage.
2.2. Petechiae in upper Petechiae in upper body.body.
04/21/2304/21/23 4848DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
3.3. Epistaxis.Epistaxis.
4.4. Hemorrhage in Hemorrhage in CNS and Retina.CNS and Retina.
3.3. Epistaxis.Epistaxis.
4.4. Hemorrhage in Hemorrhage in CNS and Retina.CNS and Retina.
Complications – Complications – Physical Physical sequel of forceful coughingsequel of forceful coughing
04/21/2304/21/23 4949DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
5.5. Pneunomothorax.Pneunomothorax.
6.6. Subcutaneous emphysema.Subcutaneous emphysema.
7.7. Umbilical and inguinal Umbilical and inguinal hernia.hernia.
5.5. Pneunomothorax.Pneunomothorax.
6.6. Subcutaneous emphysema.Subcutaneous emphysema.
7.7. Umbilical and inguinal Umbilical and inguinal hernia.hernia.
Complications – Complications – Physical Physical sequel of forceful coughingsequel of forceful coughing
04/21/2304/21/23 5050DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
TreatmentTreatment
1.1. Antibiotics are useful only in the catarrhal Antibiotics are useful only in the catarrhal stage.stage.
2.2. Once the child goes in paroxysmal stage it Once the child goes in paroxysmal stage it is very difficult to abort the attack.is very difficult to abort the attack.
04/21/2304/21/23 5151DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
TreatmentTreatment
1.1. Erythromycin 40-50 mg/kg/day in 4 divided Erythromycin 40-50 mg/kg/day in 4 divided doses X 14days. (Maximum 2 gm / 24 doses X 14days. (Maximum 2 gm / 24 hrs.)hrs.)
2.2. Respiratory Isolation for Respiratory Isolation for ≥ 5 days after ≥ 5 days after start of Erythromycin therapy.start of Erythromycin therapy.04/21/2304/21/23 5252DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Alternative drugsAlternative drugs
1.1. Clarithromycin 15-20 mg/kg/day in 2 div Clarithromycin 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 5 Azithromycin 10 mg/kg/day once daily X 5 days.days.
04/21/2304/21/23 5353DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Alternative drugsAlternative drugs
3.3. Ampicillin, Rifampicin and Cotrimoxazole Ampicillin, Rifampicin and Cotrimoxazole are modestly active against pertussis.are modestly active against pertussis.
4.4. The 1The 1stst and 2 and 2ndnd generation Cephalosporins generation Cephalosporins are not active against pertussis.are not active against pertussis.
04/21/2304/21/23 5454DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
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. – 1.04/21/2304/21/23 5555DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
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. – 1.04/21/2304/21/23 5656DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Care of Household and Close Care of Household and Close Contacts – ChemoprophylaxisContacts – Chemoprophylaxis
Erythromycin 40-50 Erythromycin 40-50 mg/kg/day in 4 mg/kg/day in 4 divided doses X 14 divided doses X 14 days regardless of days regardless of age, history of age, history of immuinisation, and immuinisation, and symptoms.symptoms.
04/21/2304/21/23 5757DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Care of Household and Close Care of Household and Close Contacts – ImmunisationContacts – Immunisation
Situation for contact < 7 yearsSituation for contact < 7 years Recommendation Recommendation
Not vaccinated against pertussisNot vaccinated against pertussis Initiate Initiate vaccinationvaccination
Partially vaccinated against Partially vaccinated against pertussispertussis
Complete the Complete the recommended recommended scheduleschedule
Received 3Received 3rdrd dose > 6 mths. back dose > 6 mths. back Booster doseBooster dose
Received 4Received 4thth dose dose ≥ 3 years back≥ 3 years back Booster doseBooster dose
04/21/2304/21/23 5858DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
PREVENTIONPREVENTIONVACCINES
PurifiedAcellularVaccine
Whole CellVaccine
04/21/2304/21/23 5959DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
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%).04/21/2304/21/23 6060DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
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.
04/21/2304/21/23 6161DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Purified acellular vaccine Purified acellular vaccine (DTaP)(DTaP)
1. Introduced in 1981 by Japan.
2. Contains subcomponents of bacteria:
1. Filamentous Hemagglutinin (Fha).
2. Pertussis Toxin (PT).04/21/2304/21/23 6262DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Purified acellular vaccine (DTaP)Purified acellular vaccine (DTaP)
3. Efficacy1. Two doses.
2. 70% protection against culture confirmed infection.
3. 80% protection against severe whopping cough.
04/21/2304/21/23 6363DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
DTP VaccineDTP Vaccine1. 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 – Deep Route – Deep intramuscular.intramuscular.
4.4. Recommended site – Recommended site – Antero-lateral part of thigh.Antero-lateral part of thigh.
04/21/2304/21/23 6464DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Vaccination Schedule Vaccination 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).
04/21/2304/21/23 6565DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
Contraindications to vaccinationContraindications to vaccination
1.1. Personal or strong family history of Personal or strong family history of epilepsy, convulsions or similar CNS epilepsy, 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 given Reaction to one of the previously given triple vaccines. triple vaccines.
04/21/2304/21/23 6666DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
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. – 3.04/21/2304/21/23 6767DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
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),
04/21/2304/21/23 6868DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
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
04/21/2304/21/23 6969DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
ConclusionsConclusions
1.1. Pertussis is a vaccine preventable Pertussis is a vaccine preventable disease caused by disease caused by Bacillus pertussis.Bacillus pertussis.
2.2. It is characterised by intensive cough It is characterised by intensive cough and whoop, and absence of other and whoop, and absence of other systemic features.systemic features.
3.3. Highly contagious disease – prophylaxis Highly contagious disease – prophylaxis of all contacts recommended.of all contacts recommended.
04/21/2304/21/23 7070DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
04/21/2304/21/23 7171DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
04/21/2304/21/23 7272DR HARIVANSH CHOPRADR HARIVANSH CHOPRA
TABLE 3 COMPOSITION OF DPT VACCINES
CONTENTS GLAXO (PER 0.5ML) KASAULI
DIPHTHERIA TOXOID
TETANUS TOXOID
B. PERTUSSIS (MILLIONS)
AI. PHOSPHATE
THIOMERSAL, B.P.
25LF
5LF
20 000
2.5 MG
0.01%
30 LF
10 LF
32 000
3.0 MG
0.01%
04/21/2304/21/23 7373DR HARIVANSH CHOPRADR HARIVANSH CHOPRA