By: Prof. Associate Dr. Malina Osman

The Pahang State Health Department has announced an outbreak of pertussis or whooping cough in the Rompin district. The media alert also mentions those who come from two districts namely Rompin and Pekan and those who want to go to those districts are recommended to take precautions to avoid the potential spread.

Pertussis infection is an infection of the respiratory system by toxins produced by Bordetella pertussis bacteria. It is transmitted through the air (from coughing and sneezing) or direct contact with nasal fluids (snot), saliva or tears.

The toxins released by the bacteria damage the cilia cells in the lungs, causing inflammation and then causing secretions or fluid (phlegm) to fail to be removed. It further causes an infected individual to cough severely as the body's system tries to remove the fluid or phlegm in question. A persistent severe cough causes breathing difficulties until possible
bring death.

This bacteria can generally infect all age groups including adults and the elderly. However, significant effects occur among children, where the severe impact occurs especially among infants who are less than a year old.

In the older group, symptoms are mild and not so noticeable that many infected are unaware of it. Those who have been infected or received the vaccine, the period of protection lasts for 4 to 20 years. Thus, some of the adults in question who experience a decrease in antibodies also have the potential to become the cause of infection among vulnerable children.

Clinical symptoms of pertussis do not occur immediately. It usually occurs after 1 or 2 weeks after the individual is exposed to the source of the infection. In the early stages of symptoms, the symptoms are similar to those of the common cold. However, unlike the common cold, it is found that there are symptoms of difficulty breathing, especially in babies and children under 5 years old.

Without early treatment, symptoms persist as persistent coughing in rapid, severe, and difficult-to-stop episodes. In medicine it is called paroxysmal coughs, where at the end of the coughing episode a 'whoop' sound is heard. It is followed by the failure of the individual to breathe normally, experiencing severe vomiting and finally stopping for a moment to breathe (apnea). Among babies who are less than a year old, their symptoms tend to manifest as difficulty breathing, skin turning blue (due to lack of oxygen) and lifelessness.

Prompt treatment to hospital allows pertussis to be treated using antibiotics and other supportive care. However, the effectiveness of antibiotics is limited by how quickly the patient receives treatment. This is because, although the bacteria in question has been successfully dealt with by taking antibiotics, the effects of the bacterial toxins that have been produced damage the cells of the respiratory system causing severe symptoms to continue to occur. Among the serious complications are sudden cessation of breathing (apnea) [68%], pneumonia [22%], seizures [2%], inflammation of the brain (encephalopathy) [0.6%] and death [1%].

Proven pertussis infections are best managed by vaccination. Previous data has shown how pertussis cases have been successfully reduced in the late 90s. It jumped again recording a number of cases that are quite significant so that research findings are needed to study the characteristics of those infected with the infection. Among the factors in question is the refusal to take the child to the clinic to be vaccinated.

Vaccination as scheduled in the National Immunization Program includes the pertussis vaccine schedule as early as 2 months of age. The vaccine for pertussis is given together with the vaccine for 5 other diseases, namely tuberculosis, diphtheria, tetanus, Hib (Haemophilus influenza b) and hepatitis B. Clearly, disease prevention efforts are carried out diligently by health workers and the Ministry of Health to ensure
children's health is not affected.

Decreased antibodies in adults and the lack of vaccine protection in children are the two main factors that have been documented in the cause of pertussis spreading in the community. At the same time, if the epidemic fails to be contained properly, we also face the threat of possible spread among the community of foreigners who are not legally registered because most of their children also do not receive vaccine protection.

Prevention and control in epidemic situations as recommended by the Department of Health should be taken seriously by all individuals in the community. This includes for the isolation of confirmed cases, separation with children who are still healthy and children under 7 years of age who have not yet been fully vaccinated must be observed.

This period of isolation and quarantine depends on the status of antibiotic administration which takes a maximum period of up to 21 days. Therefore, in order to prevent the situation from becoming more complicated, it is appropriate for local citizens who have not yet received the vaccine for their children to come forward to be vaccinated.

The author is a Lecturer in the Department of Public Health
Faculty of Medicine and Health Sciences
Universiti Putra Malaysia

Date of Input: 22/08/2023 | Updated: 22/08/2023 | aisamuddin_ahmad