Nov 28 2008
A booster vaccination for parents of new babies and other household members may be the most effective way of preventing the fatal form of whooping cough in young infants, say a group of paediatric intensive care doctors on bmj.com.
Whooping cough (pertussis) is a distressing infectious disease which affects infants and young children. Vaccination is effective and is usually given to infants at two to four months of age, with a further booster after three years. But evidence is growing that the incidence of pertussis is rising in adolescents and adults.
Infectious adults within a family are the main source of infection for unimmunised infants.
Doctors at the Royal Hospital for Sick Children in Edinburgh report two fatal cases of invasive pertussis in unvaccinated young infants.
In the first case, a one-month old boy presented to hospital with a five-day history of cough, runny nose and difficulty feeding. Both parents, and an elder sibling, reported coughing spells with vomiting in the previous two weeks.
The sibling was fully vaccinated. There was no record of the parents' childhood vaccination status but the mother received a pertussis booster in 1986.
The child was transferred to intensive care, but despite maximum therapy, died within 24 hours.
In the second case, a six-week old girl presented to hospital with a five-day history of cough and breathlessness. Her mother had a persistent cough for more than two weeks. The mother had received all her childhood immunisations including pertussis, there was no record of the father's pertussis immunisation status.
The child died within 30 hours despite maximum therapy. The patient's mother subsequently tested positive for pertussis infection.
This report demonstrates the devastating course of invasive pertussis in young infants, say the authors.
Pre-vaccination infants now account for the majority of pertussis-related complications, hospitalisations and deaths and most infants catch the disease from affected household members, with parents accounting for more than half of the cases.
As a result, several countries, including the USA and Australia, have introduced booster doses for adolescents and adults. France and Germany also recommend a targeted booster for parents and healthcare workers in contact with young children.
Mortality remains high for young infants developing invasive pertussis despite modern paediatric intensive care, say the authors. The best solution is to prevent infection. The introduction of an adult booster or more targeted vaccination of household contacts of young infants should be considered, they conclude.