The number of laboratory confirmed whooping cough (pertussis) cases in South Africa has risen dramatically, with cases doubling in just a few weeks. 

In December the National Institute for Communicable Diseases reported a total of 408 cases countrywide, with 230 of those cases in the Western Cape. Speaking to Health-e News, Professor Cheryl Cohen, Head of the Centre for Respiratory Diseases and Meningitis at the NICD said reported cases now stand at 818, but could be higher. “These numbers are a minimum estimate as many pertussis cases don’t get a specific test and are not diagnosed.”

‘Young infants are at highest risk’

From July 2022 to date,  Cohen said there’s been 14 deaths, of which 12 are children under the age of 5.

Maret Lesch, Western Cape Department of Health spokesperson told Health-e News this is because most cases were in infants too young to be vaccinated although it is a vaccine-preventable disease. 

“Young infants are at highest risk for severe pertussis disease, as they are too young to be immunised with the first dose at 6 weeks of age. But to protect those that are too young to be vaccinated, it is important that particularly the family members and close contacts of pregnant women and small infants have these routine immunisations up to date,” said Lesch.

She said that it is important for caregivers to be familiar with the signs to look out for. 

The initial  symptoms are similar to a common cold and may include nasal congestion, runny nose, mild sore throat, mild dry cough and minimal or no fever. After a few days, the cough worsens with episodes of paroxysms, followed by a whooping sound or vomiting after coughing. It’s important to note that in infants, the cough may be insignificant or not present at all, but babies may stop breathing. Caregivers should look out for a bluish skin.

“Other signs that your child urgently needs medical care, includes breathing fast(more than 50 breaths per minute). A baby under two months old who has a fever and is not feeding, is vomiting, shaking, not moving or is unable to breastfeed must get urgent care”, she added. 

Lesch has urged all children must be kept up-to-date with their vaccine schedule to ensure optimal herd immunity is achieved. According to Cohen, episodic increases in pertussis cases occurs in vaccinated populations every 3 to 5 years.

Protection from pertussis vaccine wanes

“Because the protection from pertussis vaccine wanes after a few years (i.e., it is not lifelong), additional booster doses are recommended after 4 to 8 years. These booster doses are given at 6 years and 12 years of age. In addition, pregnant women are advised to get vaccinated for pertussis to protect themselves and their infants after delivery,” said Cohen.

She said that all individuals who have not received vaccines are eligible to receive the vaccine. Whooping cough vaccines may also be given to individuals who are at risk after close contact with an infected person, depending on their vaccination status.

‘Pertussis can affect anyone’

“Pertussis can affect anyone who does not have immunity to the bacterium (Bordetella pertussis) that causes pertussis when they come into contact with someone who has pertussis. However, some individuals, for an example infants and young children who are not vaccinated or who are partially vaccinated, are at high risk for infection and severe disease,” said Cohen.

Cohen also said that individuals who have a weakened immune system and those with chronic underlying medical conditions especially chronic lung diseases are at risk of having severe pertussis disease. Very young children are likely to develop complications and die. 

After effects of the Covid-19 pandemic.

According to Cohen, the measures that were put in place to prevent COVID-19 also helped to reduce the transmission of other respiratory pathogens including pertussis, influenza etc. But following the relaxation of these restrictions, people started mixing more without wearing masks or physical distancing, and this has provided an opportunity for infections to be transmitted from one person to the other. 

“It is also possible for an increase in pertussis cases to occur when the number of people who do not have immunity to pertussis increase in the communities, that is why vaccination is so important”, said Cohen.-Health-e News