BACTERIOLOGY
azithromycin for patients over a year old. For pregnant women erythromycin is prescribed. If macrolides are contradicted, co-trimoxazole can be prescribed, but it not suitable for neonates and pregnant women. Contacts should be offered antibiotic prophylaxis if within 21 days and within a vulnerable group. Furthermore, this is extended to healthcare and other workers with infants or pregnant women.1,20
The Joint Committee on
Vaccine and Immunisation (JVCI) recommends that these groups are offered a pertussis-containing vaccine if they have not received a course or booster within the last five years.21
Vaccine
Fig 1. WHO. Diphtheria tetanus toxoid and pertussis (DTP3) immunisation coverage among 1-year-olds (%).
cephalexin containing charcoal selective agar, within a humid environment, for up to five days to culture. Growth on selective agar can be confirmed by traditional microbiology methods and matrix assisted laser desorption ionisation-time of flight mass spectrometry (MALDI-TOF MS). Detailed culture techniques can be found in the current UK Standards for Microbiology Investigations: identification of Bordetella species provided by UKHSA.2 Recently direct analysis from the primary sample can be performed by real time PCR molecular analysis. As an example, the Certest Viasure Bordetella multiplex assay can diagnose and speciate the causative organisms of whooping cough direct from patient samples.18
analysis via ELISA can look for recent
infection via anti-pertussis toxin and anti-filamentous haemagglutinin IgG antibodies. However, these assays are not validated in under two year olds, are not fast as they require host seroconversion and there are interpretating difficulties in previously vaccinated patients.19
Serological
Treatment Treatment for the majority is to treat the symptoms, isolate from nursery, school or work for 48 hours post antibiotic treatment, or 21 days from symptoms onset. Hospitalisation is required if the patient has significant breathing difficulties, particularly in children aged under six months. Antibiotic treatment choice is age related with clarithromycin for neonates and clarithromycin and
0.3 0.2 0.1
A vaccine has been available for nearly a century to help us combat pertussis disease; however, it still prevails. The evidence is overwhelming into the efficacy of well-established vaccination programmes for children and pregnant mothers to prevent disease and transmission. Vaccinated children have an 84% lower chance of catching pertussis disease than unvaccinated children. Moreover, it should be noted that this is a vaccine preventable disease.13 There are a number of suitable vaccines widely available, which usually form part of global childhood vaccination programmes. Vaccination of pertussis is usually via combination using the diphtheria, tetanus and pertussis (DTP3) vaccine. World Health Organization (WHO) data as seen in Figure 1 depicts DTP3 vaccine uptake in one year olds. National uptake varies widely, and examples include UK 92%, US 94%, Venezuela 56%, Somalia 42%, Papua New Guinea 36% and interestingly South Korea having 98% while North Korea indicates 0% coverage.13 Vaccine efficacy does decline after about two years. However, as most deaths are seen in neonates and the immunosuppressed, these vaccines can be targeted. In the UK vaccination is offered via three doses to neonates at 8, 12 and 16 weeks of age. A further pre-school booster is offered at three years four months. Interestingly in the US a further booster is offered to 11-12 year olds.17
0 Oct 23 Dec 23 Feb 24 Apr 24 Jun 24 Aug 24
Black line is 7-day moving average adjusted for bank holidays. Black dotted line is baseline.
Grey columns show weekends and bank holidays.
Fig 2. UKHSA daily incidence rate per 100,000 population for whooping cough GP hours consultations in England 11/08/2023 to 09/08/2024.23
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Pregnant women are offered a vaccine between 20-32 weeks, which is considered protective to both mother and baby.12
However, we are now seeing increases of infection of pertussis disease across the globe regardless of effective vaccination programmes. We know that the vaccine is not long lasting, but when targeted to vulnerable groups it has seen to be very effective. Access to vaccination13
and SEPTEMBER 2024
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Rate per 100,000 registered patients
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