Increase in pertussis (whooping cough) cases in Western Cape

Through our surveillance system, the Western Cape Department of Health has picked up a marked increase in pertussis cases (or whooping cough) in the province. Since January, cases have been increasing throughout the country (408), and particularly in the Western Cape where we have had 230 cases of pertussis in 2022, and most of them since September 2022. These are laboratory confirmed cases and likely represent only a small fraction of the true cases in the community. 

Pertussis is a vaccine-preventable disease, but young infants are at the highest risk for severe disease with pertussis, as they are too young to be immunized themselves as the first pertussis immunization dose is given at 6 weeks of age. It is therefore very important for caregivers to be familiar with the signs to look out for in their small ones. Sadly, 7 infants, all under the age of 2 months, have died from pertussis in the Western Cape in 2022. 

Pertussis is a highly infectious disease that affects the respiratory tract. It is caused by the bacterium Bordetella pertussis. Persons who are not immune to the bacterium through vaccination or previous infection can get pertussis at any age. However, some individuals such as infants and young children who are not vaccinated or partially vaccinated are at higher risk for infection and those with severe disease are at an increased risk. Individuals with a weakened immune system and those with chronic lung disease are also at high risk for severe disease. 
 

How is it spread

Pertussis is spread from person-to-person through respiratory excretions when an infected person coughs, sneezes etc. and a vulnerable individual inhales the bacteria. Pertussis is highly transmissible during the early stages of disease when most cases are not yet recognised. 
 

Signs and symptoms 

Pertussis can cause a wide range of symptoms which may vary from person to person. The onset of disease is gradual, and disease may be mild or severe. Symptoms usually appear 7 to 10 days after exposure; however, onset can range from 5 to 21 days. Initial signs and symptoms are like the common cold and may include nasal congestion, runny nose, mild sore throat, mild dry cough and minimal or no fever. Days later, the cough can become more severe and is characterised by episodes of paroxysms followed by a whooping sound and/or vomiting after coughing. Paroxysmal cough may last 1 to 2 months. In infants, the cough may be insignificant or not present at all, however, infants may present with cessation of breathing and bluish discolouration of the skin. Adolescents and adults who are previously vaccinated may also present differently with minimal symptoms such as a sore throat or persistent cough. 
 

How is it diagnosed?

Pertussis can be diagnosed by a medical practitioner through laboratory testing by collecting a specimen from the back of the patient’s throat (through the nose) or by coughing into a bottle to collect sputum. 
 

How is pertussis treated?

Antibiotics have been shown to be effective in reducing the infectious period. 
 

How to prevent it

Pertussis can be prevented by active immunisation with pertussis-containing vaccines. In South Africa, the Expanded Programme on Immunisation (SA-EPI) schedule includes four doses of acellular pertussis vaccine. The primary series is given in three doses at 6, 10 and 14 weeks of age in combination with other immunizations. The fourth dose (booster) is given at 18 months. To protect those that are too young to be vaccinated, it is important that particularly the family members and close contacts of pregnant women or small infants have these routine immunizations up to date. 

When a case of pertussis is diagnosed, close contacts (persons with face-to-face exposure, including health care workers) of the patient should receive antibiotic prophylaxis regardless of age or vaccination status with erythromycin for 7 days, or azithromycin for 5 days. 

Containment measures are in place at health facilities as part of standard infection control to limit the possible risk of infection, including isolating the cases, wearing masks and antibiotic prophylaxis to contacts. While we have several prevention measures in place, we call on all caregivers to be vigilant of the signs and symptoms. Should they pick up any of the symptoms in their children, they should take them to their nearest health facility immediately. 
 

General disease prevention

Over the next few weeks, we will be coming into contact with many more people than usual. During this time there is also the risk of many bugs/diseases circulating. It is crucial that we continue protecting our personal space through good hand hygiene practices. And should you not feel well, cough or sneeze, you can protect others by avoiding social gatherings when you are sick or voluntarily wearing a mask when you socialize with others.