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A major outbreak of pertussis (commonly known as whooping cough) has been ongoing in the UK since early 2024. There have been 2,793 confirmed cases so far this year. Sadly, five infants have been confirmed dead due to whooping cough, with unconfirmed reports suggesting a sixth may have died from a bacterial infection last week.
This is a clear reminder that whooping cough is a very nasty infection. While symptoms are usually mild in healthy older children and adults, it can be fatal for infants. (Also read | Whooping Cough Outbreak: Symptoms to Watch Out For; Treatment and prevention tips by experts,
Globally, there are an estimated 24 million cases of whooping cough each year and approximately 160,000 deaths.
Whooping cough is caused by a bacteria called Bordetella pertussis. Pertussis often begins like most other respiratory infections, with typical symptoms including runny nose and fever. The characteristic “whooping” cough may appear as early as a week or two after illness – although this does not occur in all cases. However, laboratory testing may be required to confirm cases of whooping cough.
Whooping cough is very contagious. On average, one case of pertussis can spread the infection to about 15-17 other people. This infection rate is similar to that of measles and higher than the Covid variant.
The reason whooping cough is so contagious is partly due to pertussis, which has an infectious period of up to five weeks – where infected people can spread the bacteria to others. Prompt treatment can significantly reduce transmission – antibiotics are able to reduce infectiousness just five days after starting treatment.
But before treatment, there are many opportunities for transmission to occur and outbreaks to persist. Both confirmed and asymptomatic cases can be responsible for the further spread of whooping cough.
Why have cases increased?
One strange aspect of whooping cough is that large outbreaks usually occur every few years. The last major outbreak in the UK occurred in 2016, with around 6,000 confirmed cases. The reasons for these cycles are not fully understood, but a major factor is probably waning immunity at the population level.
Immunity from pertussis vaccine is initially very protective, but wanes a few years after the initial vaccination. This is why continued high vaccination across the entire population is important.
The vaccine is very safe and effective. Vaccination of young children and pregnant women – some of the most vulnerable groups of the population – is especially important to prevent infection and disease.
Children who are fully vaccinated are 84 percent less likely to be diagnosed with whooping cough than those who are not vaccinated. Vaccines not only prevent young children from getting sick – vaccines also reduce the risk of children spreading infections to younger siblings, family members and friends.
Vaccination during pregnancy is also especially important because the antibodies the mother gets from the vaccine protect the newborn baby in the first few weeks of life – even before the baby is old enough to receive his or her first pertussis vaccine dose. Go. A single dose during pregnancy prevents about 78 percent of cases of pertussis in newborns.
But vaccine coverage has declined in recent years. Maternal vaccination percentage was 70 percent in 2017, but only 58 percent in 2023.
The percentage of children vaccinated by their first birthday dropped slightly from about 93 percent just before the pandemic to 92 percent in 2022-2023. A similar drop (from 85 percent to 83 percent) is seen with a booster dose given to children before their fifth birthday. This decline in coverage may contribute to the current outbreak.
While one publication has suggested that the outbreak is possibly “an increase caused by lockdowns”, there is no evidence to support this claim.
This type of messaging is not useful because it does not raise awareness or educate the public about things they can do to prevent the spread of whooping cough. Given that people’s health behavior can be significantly influenced by the news they read, high-profile media sources have a responsibility to report accurate information.
The broad extent of the pandemic has impacted access to health care and vaccination rates, resulting in a decline in the population-wide immunity needed to prevent serious outbreaks. Geographic variations in vaccine uptake may also be a contributing factor – although, at the time of writing, there is no data available on case numbers by UK region.
To control the current outbreak, widespread use of antibiotics will likely be used to treat or prevent pertussis infection. If someone suspects they have whooping cough, they should talk to their doctor as soon as possible – not only because of the severity of the illness, but also because prompt treatment shortens a person’s infectious period.
While UK guidance does not routinely recommend pertussis vaccine in adults, an additional dose is considered safe and effective. This advice may be given to people who have come in close contact with someone who has whooping cough. It may also be important for people who may be more vulnerable to serious infections – such as the elderly.
Ultimately, whooping cough is an infection that can be prevented by vaccines. The grim news of infant deaths in the UK reminds us all that there are very good reasons to recommend vaccination. And, in the long term, the outbreak can be reduced in both the number of cases and the severity of cases by maintaining high vaccine coverage.
Access to vaccination, as well as accurate information about the small risks and significant benefits, will be critical in bringing the outbreak under control.
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