According to the "National Overview of the Epidemic of Notifiable Infectious Diseases" released by the National Bureau of Disease Control and Prevention, from December 2023 ~ February 2024, the number of new cases of pertussis is 41,506, a significant increase compared with the same period, and there are deaths.
As a category B infectious disease, pertussis is caused by bordetella pertussis infection, which can be transmitted through respiratory droplets and is highly contagious.
According to Shen Jun, chief physician of the Department of Infectious Diseases and Infectious Diseases of the Children's Hospital of Fudan University, the current clinical risk of severe pertussis and death is mainly concentrated in infants under 6 months old, while adolescents and adults are mainly carriers of germs, and the general symptoms are not obvious.
Shen Jun, chief physician of the Department of Pediatric Infectious Diseases of the Children's Hospital of Fudan University, diagnosed and treated the children. Photo courtesy of the interviewee
Who is at risk? Babies under 6 months old should be especially careful
Wang Siyu (pseudonym) was just 5 months old and coughed for 2 weeks, often coughing until her face was red and she couldn't breathe, and her parents were frightened by a violent and unusual cough. In the Children's Hospital Affiliated to Fudan University, Wang Siyu was diagnosed with whooping cough, cyanosis around the lips and cold limbs at the time of treatment.
Shen Jun told the Health Times, "Some children have repeated severe coughs, which are very severe, sometimes leading to almost 'suffocation', which is a typical symptom of whooping cough." ”
Whooping cough is often distinctly different from a normal cough. Liu Hua, chief physician of the Department of Pediatrics of the First Affiliated Hospital of Guangzhou University of Chinese Medicine, told the Health Times reporter that this kind of cough is often a long series of uncontrollable coughs, which can only be stopped if you cough up phlegm or cough until you vomit.
Liu Hua explained that due to the inflammation of the larynx, trachea, bronchi, etc., caused by bacteria, a large amount of viscous secretions will be produced, which stimulate the peripheral nerves of the respiratory tract and cause a spastic cough through the cough center, which will not stop until the secretions are discharged. Because during a long series of coughs, the child basically does not inhale, so after the cough is over, it must be inhaled forcefully to ensure that the oxygen supply is sufficient, and the forced inhalation will cause a breathing sound like a rooster crowing.
"Clinically, the high-risk group for whooping cough is infants under 6 months of age, and severe disease often manifests as pneumonia and encephalitis. Shen Jun said.
According to the analysis of laboratory and clinical diagnosis of pertussis reported by the Chinese Disease Control and Prevention Information System in 2018~2021, it was found that children aged 0~4 years (55909 cases, 84.49%), of which infants were the main ones (34675 cases, 52.4%). About 75% of children diagnosed with pertussis can be complicated by pneumonia, and 5% of children can be complicated by encephalopathy.
How is whooping cough transmitted? Adolescents and adults are the main sources of infection
The sharp increase in new cases of whooping cough this year compared with the same period in previous years may be related to the missed diagnosis of adolescents and adults.
The upward trend of pertussis epidemics has begun to be noted in the "Risk Assessment of Public Health Emergencies of Concern in China in January 2024" published by the authoritative journal Disease Surveillance. "The increase in the number of reported cases of pertussis may be related to a variety of factors, such as increased surveillance sensitivity and cyclical increases in disease epidemics".
And this is consistent with the situation that Shen Jun encountered in the clinic. Shen Jun told the Health Times reporter that the sharp increase in whooping cough cases this year compared with last year is indeed due to the fact that we have paid attention to testing and better equipment, and more pertussis patients have been diagnosed. However, it should be noted that most of the patients with whooping cough are infants and young children, and they often stay at home, so how do they get infected with infectious bacteria?
The source of infection of whooping cough is the patient and the carrier. It is contagious from the beginning of the incubation period to 6 weeks after the onset of the disease, especially from the end of the incubation period to the late stage of the disease (the bacteria grow and multiply on the trachea and bronchial mucosa, stimulating the respiratory mucosa and causing inflammation) and the most infectious is within 2~3 weeks.
However, in a number of pertussis studies, it has been found that the incidence pattern of pertussis has gradually changed from the traditional "child-child" to "adolescent/adult-neonatal/child".
The Pertussis Diagnosis and Treatment Plan (2023 Edition) issued by the National Health Commission proposes that adolescents and adults become the main source of infection of pertussis in infants.
Shen Jun told the Health Times reporter that adolescent and adult whooping cough patients often have no obvious symptoms, the degree of illness is mild, similar to the common cold cough, they rarely go to the hospital for medical treatment, or clinically do not consider that it may be whooping cough, but carrying the germs will be transmitted to the baby at home.
Studies have shown that there are multiple modes of transmission in the family cluster of pertussis in mainland China, and the mode of transmission from adolescents/adults to infants and young children accounts for 80% of all cases.
Is the vaccine still effective? Get vaccinated and complete the immunization program in a timely manner
"Most children who are infected with pertussis for the first time are those who have not been vaccinated against pertussis or have not completed the pertussis immunization schedule. Shen Jun, Liu Hua and other experts said.
At present, the vaccines used in the mainland are diphtheria toxoid, acellular pertussis vaccine, and tetanus toxoid vaccine. The vaccination time is 3 months old, 4 months old, 5 months old, and 1 dose at 18 months old.
"Many infants and toddlers may miss their vaccinations at the time of vaccination due to illness or other factors. Liu Hua believes that the number of people infected with whooping cough is relatively large, and reminds infants and young children who have not been vaccinated to be vaccinated in time and complete the full immunization program.
However, "even if you have been vaccinated or have been infected with whooping cough, you can't rule out the possibility of reinfection." Liu Hua introduced that clinically I have encountered many children who have been vaccinated and re-infected, and there are also cases where I have whooping cough when I was a child and am infected again when I am an adult.
In 2015, the World Health Organization (WHO) issued a document that the recurrence of pertussis in some countries in recent years may be related to the widespread use of acellular diphtheria-pertussis combination vaccine. According to the different vaccine production processes, pertussis vaccines can be divided into whole-cell pertussis vaccine (wP) and acellular pertussis vaccine (aP). The mainland is currently using acellular pertussis vaccine (aP).
Liang Xiaofeng, former deputy director of the Chinese Center for Disease Control and Prevention and vice president of the Chinese Preventive Medicine Association, told the Health Times that before 2007, the mainland pertussis vaccine used the whole cell pertussis vaccine, and after 2007, the mainland gradually replaced it with the acellular pertussis vaccine, and completed the replacement in 2013. Because of the high incidence of adverse reactions to whole-cell vaccination, especially local reactions, many parents and children cannot accept them. China gradually completed the replacement of vaccines with reference to the recommendations of the WHO and foreign experience, but later found that the protection rate of acellular pertussis vaccine is not as good as the original, which is also a public health problem facing the world.
How can parents protect their children?
Once a child suffers from whooping cough, whether to isolate at home, how to isolate, when to release isolation, and how to protect the family have become topics of concern for many parents.
According to Shen Jun, the general incubation period of whooping cough is 5~21 days, which is often divided into catarrhal stage, spasmodic cough stage, and recovery period. During the catarrhal phase, the contagiousness of the patient is high, and it is best for the patient not to go to school, work, etc., and to isolate at home.
According to the recommendations of the Continental Center for Disease Control and Prevention, if a child or family member is diagnosed with whooping cough, other family members should also use antibiotics to prevent it, and the patient should not touch the baby for the first 5 days of antibiotic treatment. After the diagnosis of whooping cough, the isolation should be released after 30 days of cramping, and the specific isolation time should be based on the doctor's recommendation.
Since the symptoms of whooping cough infection in adults are not obvious, in order not to infect infants and young children at home, Liu Hua suggested that parents must wash their hands frequently and wear masks after coughing symptoms. It is important to be careful when dealing with infants and young children, for example, you can change your clothes for working outside the home before touching them at home.
In addition, Shen Jun told the Health Times reporter that in order to protect infants who have not reached the initial age of vaccine immunization, foreign countries generally implement the pertussis "cocoon strategy" plan, that is, to vaccinate adults (parents, grandparents and caregivers) around the baby to form a protective mechanism like a "silkworm cocoon", thereby reducing the risk of morbidity, severe disease and death of infants and young children. However, due to the low willingness of domestic parents to know about pertussis disease and vaccine, the "silkworm cocoon plan" in mainland China still needs to be promoted.
According to the "Survey on the Willingness of Parents of Children Aged 0~6 Years Old in Minhang District, Shanghai to Vaccinate the Pertussis Vaccine "Cocoon Strategy" Vaccination Willingness of Children Aged 0~6 in Minhang District, Shanghai, if adult pertussis vaccine is provided, more than seventy percent of children's parents will take the initiative to vaccinate against whooping cough in order to protect their infants. Family contact has been shown to be the most important source of pertussis infection in newborns, but not all parents are aware of it.
How to use medicine to stop cough quickly? The combination of traditional Chinese medicine and Western medicine has a good effect
Since pertussis is caused by pathogens, the "Pertussis Diagnosis and Treatment Plan (2023 Edition)" issued by the National Health Commission shows that macrolide antibiotics such as azithromycin, erythromycin, roxithromycin or clarithromycin are preferred for the treatment of pertussis. For symptoms such as cough and runny nose, symptomatic treatment is still the mainstay.
Whether it is diagnosis or treatment, Shen Jun reminded parents that it is recommended to go to a specialist pediatric outpatient clinic, because the community does not have the ability to diagnose pertussis, and the current domestic circulating strains of pertussis are resistant to macrolides including azithromycin, and it is recommended to consult a pediatric specialist for the use of antibiotics. Pertussis tends to have a long course and a risk of complications, so treatment is relatively complex and requires individual diagnosis and treatment, although most patients are cured.
Due to the prolonged cough, many children are often tormented. According to the clinical symptoms, whooping cough belongs to the category of "cough", "spasmodic cough" and "heron cough" in traditional Chinese medicine, and traditional Chinese medicine treatment has unique advantages.
Liu Hua introduced that it is necessary to choose antimicrobial drugs under the guidance of doctors. Treatment of whooping cough can be done through traditional Chinese medicine. The main pathological factors of pertussis or pertussis-like syndrome in children are the lungs and liver, and the main pathological factors are phlegm, heat and wind.
The "Pertussis Diagnosis and Treatment Plan (2023 Edition)" issued by the National Health Commission also proposes traditional Chinese medicine methods at different stages of the disease. In the first cough stage: Gantang soup is recommended for mild cases, once in the morning and once in the evening, and for severe cases, Ma Xingshi Gantang is recommended. Spasmodic cough stage: Ning cough decoction is recommended for mild cases, and Qianjin reed stem decoction and phlegm reqing injection are recommended for severe cases. Downtime: Recommended sand cucumber wheat soup.
The Department of Pediatrics of the First Affiliated Hospital of Guangzhou University of Chinese Medicine will also use the method of acupuncture point application to relieve cough for children with whooping cough.
From a series of coughs to occasional coughs, Liu Hua was deeply relieved to see the condition of the hospitalized little patients improving day by day. However, judging from the current clinical situation, many adult pertussis patients are missed, and the potential impact on children is particularly worrying.
Liang Xiaofeng told the Health Times reporter that it may be our long-term strategy to deal with the challenges by carrying out research on the effective components of pertussis vaccine research and strengthening immunization of adolescents with pertussis-containing vaccines, exploring selective immunization strategies for high-risk groups, and developing more protective vaccines.
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