Causative Agent
Bordetella pertussis and, occasionally, B. parapertussis.
Clinical Description
Whooping cough is an acute bacterial disease of the respiratory tract,
resulting from infection with Bordetella pertussis, or occasionally
milder disease with B. parapertussis. Onset is insidious with
an initial catarrhal stage causing an intermittent irritating cough
that gradually becomes paroxysmal within one to two weeks. Paroxysms
comprise a series of coughs, without opportunity for inspiration, followed
by the characteristic inspiratory 'whoop'. The paroxysmal phase may
last for two to three months, and apnoea, cyanosis, and post-tussive
vomiting may occur. Complications of whooping cough include bronchopneumonia,
acute encephalopathy, and long-term brain damage as a result of cerebral
hypoxia. Complications and deaths from whooping cough are most frequently
seen in infants less than six months of age; this prompted the introduction
of an 'accelerated' UK primary immunisation schedule for vaccination
at two, three, and four months of age. Those too young to be vaccinated
continue to be at highest risk of severe disease. The disease is generally
mild in adolescents and adults.
Transmission
Respiratory transmission through contact with an infectious individual.
The incubation period is between six and 20 days, usually seven to ten
days. Infected individuals are most infectious in the initial catarrhal
phase, before onset of paroxysms. Communicability then declines, and
by three weeks after onset of paroxysms an individual may be considered
non-infectious for non-household contacts.
Surveillance in Scotland
- Statutory notification of whooping cough
- Laboratory reports for Bordetella pertussis and B.
parapertussis
Definition for Surveillance Notification (suggested)
Any person with cough, illness lasting two or more weeks with one
of the following:
- paroxysms (i.e. fits) of coughing
- inspiratory "whoop"
- or post-tussive vomiting
- without other apparent cause
(Centers for Disease Control and Prevention/World Health Organisation)
Laboratory Report
Laboratory reports for Bordetella pertussis, or B. parapertussis.
Incidence
Prior to vaccine introduction, large epidemics of whooping cough occurred
every three to four years, and in 1951 there were nearly 23,000 notifications.
Marked reductions in vaccine uptake in the 1970s, as the result of unfounded
public and professional anxiety about the safety of pertussis vaccine,
led to three epidemics of the disease. It has only been in the last
decade that the incidence of whooping cough has returned to levels occurring
before adverse publicity. Whooping cough continues to show an epidemic
cycle, but with much smaller peaks. The last period of increased incidence
was in 1997-98.
| Year |
Notifications |
Laboratory Reports |
| 2000 |
93 |
86 |
| 2001 |
106 |
79 |
| 2002 |
99 |
109 |
| 2003 |
60 |
50 |
| 2004 |
87 |
48 |
| 2005 |
51 |
59 |
| 2006 |
67 |
54 |
| 2007 |
98 |
62 |
| 2008 |
134 |
117 |
| 2009 |
104 |
118 |
| 2010* |
47 |
82 |
| |
*Provisional data
|
Prevention
Immunisation against whooping cough was introduced in the UK in
the 1950s. Whole cell pertussis vaccine is still included in the UK
childhood immunisation schedule, with routine primary vaccination
recommended at two, three and four months. A pre-school booster of
acellular pertussis vaccine was added to the UK Childhood
Immunisation Schedule, with effect from January 2002 in Scotland.
The booster was introduced as there was evidence that infants, too
young to be protected through vaccination, may be catching pertussis
from older siblings, or parents with waning immunity. Chief Medical
Officer letter, 9 November 2001, Current pre-school acellular pertussis
booster: http://www.show.scot.nhs.uk/sehd/publications/CMO(2001)16.pdf
(
)
Further Information
Historic notification data
Information relating to notifications of infectious diseases for the most recent year are summarised as key points with more detailed tables and charts available. Previous year's data are included in the tables and charts.
Public Health etc. (Scotland) Act
The Public Health etc. (Scotland) Act 2008 provides a statutory framework for public health action to protect the people of Scotland from infectious disease, contamination and other such hazards.
Vaccine Uptake
EUVAC.NET
EUVAC.NET is a surveillance community network for vaccine preventable infectious diseases
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