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Whooping Cough Cases Surge Worldwide. Here’s Why

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There is a worrying rise in whooping cough outbreaks in 2024. In Europe, Asia, and parts of the US, a sudden surge in cases has experts concerned. Such surges occur periodically and vary from country to country. However, the most recent uptick in the UK and Europe is the largest since 2012. 

According to the BMJ, in January 2024 alone, England experienced 553 cases compared with 858 for the whole of 2023. China recorded more than 15,000 cases in the same time period – a 15-fold rise year-on-year. Elsewhere, cases have been reported in the San Francisco Bay Area, Hawaii, and New York City. 

What’s going on? 

What is Whooping Cough? 

Whooping cough, also known as pertussis, is a highly contagious respiratory infection caused by the bacterium Bordetella pertussis. It is characterized by severe coughing fits that often end with a “whooping” sound as the person breathes in. The disease primarily affects infants and young children but can also occur in adults.  

Whooping cough is notorious for its symptoms that can last for weeks – it’s often called the ‘100-day cough’ – leading to complications such as pneumonia and, in severe cases, death. Vaccination is the most effective preventive measure, particularly for children and those in close contact with young infants. 

What’s Happening? 

Usually, whooping cough is well-controlled in the population due to high rates of vaccination. Before the introduction of vaccines, the US averaged around 180,000 cases annually – 93% occurred in children younger than 10. 

Incidence rates dropped dramatically after 1950 as vaccination became widespread. Thankfully, the US population remains heavily vaccinated, ensuring whooping cough is controlled. However, the UK Health Security Agency warned that the steady decline in whooping cough vaccination in pregnant women and children is behind the recent surge in cases. 

As of September 2023, only 92.9% of two-year-olds completed their essential six-in-one vaccinations, including pertussis protection, a drop from 96.3% in March 2014. Similarly, the uptake of the maternal pertussis vaccine during pregnancy has decreased significantly, from over 70% in September 2017 to just 58% in September 2023. 

Other outbreaks appear to be incidental rather than connected. In China, the exclusive administration of ‘acellular vaccinations’ (ACVs) as part of the national immunization program marked the beginning of the sudden uptick in cases. Levels in the Middle Kingdom soared to rates not seen since the 1980s. 

Other outbreaks appear to be incidental rather than connected. In China, the exclusive administration of ‘acellular vaccinations’ (ACVs) as part of the national immunization program marked the beginning of the sudden uptick in cases. Levels in the Middle Kingdom soared to rates not seen since the 1980s. 

Identifying Whooping Cough Symptoms 

After exposure to the bacteria Bordetella pertussis, an incubation period of 7 to 14 days occurs (range 6 to 20 days). Following this, the child will enter the catarrhal stage. Symptoms include: 

  • Runny nose 
  • Low-grade fever 
  • Mild, occasional cough
  • Nasal congestion
  • Sneezing 
  • General malaise 

This stage lasts 1-2 weeks before entering the paroxysmal stage. Here, the characteristic whooping cough begins. Look for: 

  • Fits of rapid coughing followed by a high-pitched “whoop” sound during the intake of breath 
  • Vomiting after coughing 
  • Exhaustion after coughing fits 
  • The face may turn red or purple during coughing spells 

Only around 50% of children and adults “whoop” during this stage. It can last anywhere from 2 to 8 weeks – or even longer. Gradually, the child transitions to the convalescent stage. Symptoms include: 

  • Gradual recovery 
  • Coughing fits become less frequent and less severe 
  • Cough can last for weeks or even months, commonly known as the “100-day cough” 

This final stage persists for a further 1 to 4 weeks. The symptoms begin to decrease, and the child will feel better. In the US, pertussis is fatal in an estimated 0.5% of cases in under 1s. Other complications include pneumonia, seizures, encephalopathy, and apneas.  

Importance of Vaccination 

The alarming resurgence of whooping cough globally underscores the critical importance of vaccination. Vaccination skepticism has grown significantly in recent years, fueled, in part, by the COVID-19 pandemic. Prominent public figures have expressed doubts about the COVID-19 vaccine, with some even expressing concerns about vaccine efficacy in general.

Less appreciated is the prevalence of vaccine skepticism in Europe. In France, for example, one in three people believe vaccines are unsafe. Similar numbers are seen in Italy, Poland, Hungary, and across the continent.  

Erroneous claims linking vaccines to autism or myocarditis (COVID infection carries a greater risk of myocarditis than the vaccine) have spread this doubt. Now, children are reaping the consequences.  

Maintaining high vaccination coverage within communities is the best tactic for eliminating and controlling infectious diseases. Addressing vaccine hesitancy and misinformation, ensuring vaccine accessibility, and reinforcing public health campaigns are critical steps towards mitigating the current outbreak of pertussis. 

If we neglect vaccinations, the diseases we thought were behind us will inevitably resurface. It’s just a matter of time. 

 

Written by: Emmanuel J. Osemota 

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