Whooping cough in infants: How can it be prevented?

Whooping cough is in principle a harmless, but unpleasant illness:

  • The cough lasts an average of six weeks and in some cases leads to vomiting
  • For the first three weeks the cough is contagious; since the diagnosis is often made in the second week the child must be taken care of at home for one to two weeks
  • Occasionally there are complications such as pneumonia or ear infections
  • Sometimes a cough that is induced by physical activity can persist for months

The main problems arise in the cases where infants become ill in the first three to four months of life. Almost all whooping cough complications (pneumonia, respiratory distress during a strong episode of coughing, central nervous system involvement) occur during this phase. There are even fatalities—one in 1,000 to 10,000 infants that become infected with whooping cough die as a result.

This was the reason that the vaccination was implemented: vaccinated older siblings would bring home whooping cough less often. Due to the unreliable and short effect of the vaccination this does not always work out: in Australia, for example, vaccinated older siblings are the most common reason for infected infants (Bertilone 2014).

The search for a better way to protect infants is ongoing.

  • Kokon-strategy (= vaccination of further contact persons such as parents, grandparents, babysitters, etc.): close contact persons – primarily the mother – are responsible for one to two thirds of infant cases of whooping cough. However, mathematically one would have to vaccinate 5,000 contact persons to prevent one single case of whooping cough in one infant, 10,000 – 60,000 to prevent one hospitalization, and one to twelve million to prevent one fatality (see Lim 2014, Gilly 2014). These numbers most likely do not even represent the real situation: even vaccinated persons can carry whooping cough bacteria and spread them (Warfel 2014). The transmission is most likely even more probable in such cases because the carrier does not feel sick and does not have a reason to avoid contact with infants (Althouse 2015). Many experts thus deem the Kokon strategy a failure, even though the STIKO still continues to follow it. In my own experience I have seen that not only children, but also adults, do not tolerate the whooping cough vaccine well: many people have a fever and feel sick for a period of several days.
  • Whooping cough vaccination during pregnancy (after the 30th week of gestation): Due to the transfer of whooping cough antibodies over the placenta an infant could be protected from random contact with whooping cough bacteria, which account for about one third of the infections (see MMWR 2012). This strategy is cheaper than the Kokon strategy, but its efficacy is disputed. There are risks for the fetus: in a study conducted in the United States of America vaccinated individuals showed a higher rate of amnion infections which can be life threatening for the new born child (Kharbanda 2014). The aluminum in the vaccine could also have neurological and immunological side effects for the fetus.
  • Vaccinating newborns: This strategy is disputed in its efficacy and has the disadvantage that children respond to later vaccinations (whooping cough, Hib- and Hepatitis B) with lower antibody production.

So what is to be done?

The best option, to take up one more message in our already saturated conscience of health risks:

  • Parents should get tested for whooping cough, when they have an unusually persistent cough that originates from the larynx or breastbone and is not suppressible.
  • Kindergarten children should be tested if they are coughing and cases of whooping cough or coughs with similar symptoms are known of in the establishment.
  • Parents of young infants should prevent any coughing in close proximity to their infant. Any cough is cumbersome for an infant, whooping cough especially so.

The diagnosis of whooping cough can be made with the analysis of a nasal swab within one to two days. If it is a case of whooping cough, the transfer to a baby can be prevented by antibiotic treatment, for the sake of prevention the entire family should be treated.

Martin Hirte 4.7.2015

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