1 April 2009

Booster immunisation against pertussis (whooping cough) is necessary to protect adolescents and adults against the disease especially during epidemics, according to respiratory experts.

Pertussis is now more common in people aged 15 years and over than it is in children. Disease outbreaks have been associated with waning immunity in older children and adolescents, write Dr Julie Marchant and Professor Anne Chang of the Royal Children's Hospital in Brisbane, in the latest edition of Australian Prescriber.

“It is vital to remember that adolescent and adult vaccination is an effective means of controlling Bordetella pertussis and will have positive health ramifications within the community,” Dr Marchant says.

The disease is thought to be under-diagnosed. “The classic presentation of spasms of coughing with the characteristic inspiratory whoop is less common in older children and adults,” she writes.

“When B. pertussis is diagnosed early, antibiotics can decrease the infectious period, but have no effect on the duration or severity of disease.”

“Antibiotics are recommended in the initial catarrhal phase of infection when they are effective in eliminating B. pertussis from the nasopharynx.”

“However, after three weeks of coughing, antibiotics have no measurable effect in reducing the infectious period and are not recommended,” Dr Marchant says.

Patients should avoid contact with susceptible individuals such as unvaccinated babies until at least five days of antibiotics have been taken. Antibiotic prophylaxis for 'high-risk' contacts of pertussis cases is recommended, but there is limited evidence of its effectiveness.

Childhood immunisation has been effective in preventing pertussis, and unimmunised infants are the most at risk of having severe, life-threatening disease.

The current Australian recommendations are that children should be immunised at two, four and six months of age with a booster at four years of age and another booster at 12–17 years of age.

For a full copy of the article visit www.australianprescriber.com.

ENDS

Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals, particularly doctors in general practice. It is published by the National Prescribing Service Limited (NPS), an independent, non-profit organisation for Quality Use of Medicines funded by the Australian Government Department of Health and Ageing. Australian Prescriber is distributed every two months in hard copy to health professionals, free of charge, and online in full text at www.australianprescriber.com.