Pertussis Support

* Preventive care: Vaccination

Pertussis vaccine
In France, the pertussis vaccine was introduced in 1959 it was extended in 1966 because of its association with diphtheria, tetanus and polio. (1)

Since the introduction of vaccination, it was found:

* 95% collapse in the number of pertussis cases and deaths
* But a resurgence of the disease in adolescents and adults.

The currently used vaccine (acellular) is better tolerated than the older vaccine (whole cell vaccine) that marketing is currently stopped. The secondary reactions, especially fever are less frequent. (6.10)

The pertussis vaccine provides immunity excellent but transient (not exceeding ten years): Callbacks vaccine are needed. (7)

In France, the vaccination is recommended at the age of 2 months because the infant pertussis can cause serious and sometimes fatal.

General recommendations (3)

Vaccination against pertussis is practiced with the acellular pertussis vaccine combined with other valences.

The primary immunization of infants has three injections one month apart, followed by a booster at 16-18 months. Given the persistence of a high incidence of pertussis in young infants, infected adolescents or young adults, a booster is recommended since 1998, between the ages of 11 and 13 years.

This second recall in early adolescence should be practiced in conjunction with the third recall diphtheria, tetanus and polio with a vaccine DTCaPolio.

For children who have escaped this recall at 11-13 years, catching up will be performed by the administration of a quadrivalent vaccine DTCaPolio, at the age of 16-18 years.

For children who received out recommendations, a pertussis booster at age 5-6 years, the pertussis booster 11-13 years will be deferred and a quadrivalent vaccine dTcaPolio be proposed at the age of 16-18 years.

In addition to the strategy called cocooning (see below "specific recommendations"), catching up with the pertussis vaccine quadrivalent dTcaPolio be proposed at any adult who had not received vaccination against pertussis during the last ten years, including at the decennial booster diphtheria-tetanus-polio 26-28 years, with the quadrivalent vaccine dTcaPolio.

In the current state of knowledge, including the duration of protection and safety of repeated doses, there is no need to administer more than one dose of quadrivalent vaccine dTcaPolio adults.

Specific recommendations (3)

Vaccination against pertussis is also recommended for adults who become parents in the months or years (called cocooning strategy), and during pregnancy. The updating of vaccinations for other family members (children not updated for this vaccination, adults who have not received vaccination against pertussis during the last ten years) is also recommended as follows:

* During pregnancy for the father, brothers and sisters possible and, where applicable, the adult responsible for the custody of the infant during the first 6 months of life, but also the grandparents may occasionally keep their grandchildren ;
* For the mother immediately after birth (breastfeeding is not a cons-pertussis to vaccination);

In adults, the minimum time between vaccination DTPolio administration of quadrivalent vaccine dTcaPolio can be reduced to two years.

Occupational hazards (3)

Vaccination against pertussis is recommended for:

* Nursing staff as a whole, including in residential homes for frail elderly (retirement homes), with a quadrivalent vaccine dTcaPolio at a point ten DTPolio,
* Students of medical and paramedical courses, on the same principle as the caregivers,
* Professionals in contact with infants too young to have received three doses of pertussis vaccine,
* The medical and paramedical staff of maternity hospitals, neonatal units, or any department of Pediatrics supports infants under 6 months
* Staff of early childhood (nursery, daycare, ...).

For all of these medical professionals, paramedical and in contact with infants, small children or the elderly, the minimum time between vaccination DTPolio the quadrivalent vaccine dTcaPolio can be reduced to two years.

Upon the occurrence of clusters in communities, this period may be reduced to a month.

Schedule of immunization against pertussis

* Primary immunization of infants: one dose at 2, 3 and 4 months and a booster dose at 16-18 months with a combined vaccine.
* Call to adolescence at 11-13 years (1 dose with a vaccine DTCaPolio).
* Call to adulthood at 26-28 years but if draft parenting, family environment of a pregnant woman, and no vaccination against whooping cough for 10 years (1 dose with a vaccine dTcaPolio ).

Note: A single dose of quadrivalent vaccine is now sufficient dTcaPolio adults. (3)

The goals of adult immunization against pertussis are:

* Reduce the incidence of pertussis in adolescents and adults
* Reduce the contamination of newborns and small infants unvaccinated
* To increase the immune vaccinated groups vis-à-vis this bacterium
* Reduce the circulation of this bacterium

Despite these recommendations, pertussis vaccination coverage in adults remained insignificant in 2006 (7)

* The cure

* Antibiotic treatment:
Antibiotic treatment has no effect on the evolution of the disease and has little effect on the cough but it is nevertheless essential because it eliminates the presence of the bacterium in nasopharyngeal secretions in 3-5 days, which decreases the risk of contamination. (7)
Antibiotic treatment is recommended for all persons in the immediate environment of the patient regardless of age or immunization status.

* Hospitalization in specialized of all infants younger than 3 months is systematic, constant surveillance with a cardiorespiratory monitor. (6.8)

* The single room isolation is important as the subject is contagious, that is to say during the five days following the initiation of appropriate antibiotic treatment. (6)
* A satisfactory hydration.
* From the Respiratory physiotherapy to ensure drainage and bronchial pulmonary ventilation satisfactory.
* An adequate supply of food, split, or energy supplements