Prevention of neonatal whooping cough in England: The essential role of the midwife
Following an increase in the incidence of whooping cough (pertussis) in the general population from 2011, coupled with neonatal pertussis mortality seen in 2012, a programme of maternal pertussis immunisation was introduced to the UK in the same year. The programme aims to provide passive immunity from birth, until active immunity can be provided through the routine immunisation programme from 8 weeks of age. Since its introduction, evaluation of the vaccine given in pregnancy has demonstrated its safety, efficacy and patient acceptability. Uptake of the vaccine has reached 70% and its continued use is an opportunity to protect newborn babies from a serious and sometimes fatal vaccine-preventable infection. Midwives should discuss pertussis immunisation with pregnant women and either signpost them to their GP to receive it or, if commissioned to do so, administer the vaccine themselves.
Pertussis is a vaccine-preventable disease of global public health significance. Estimates from the World Health Organization (WHO, 2011) suggest that, in 2008, about 16 million cases of pertussis occurred worldwide, 95% of which were in developing countries, and about 195 000 children died from the disease. In the UK, it remains the most common vaccine-preventable cause of death in children under the age of 1 year (Amirthalingam, 2013). Pertussis is a cyclical disease, with increased pertussis activity occurring every 3–4 years (Health Protection Agency (HPA), 2012).
Pertussis is a highly infectious and sometimes fatal infection caused by the bacterium Bordatella pertussis. It is easily transmitted by respiratory droplets and has an incubation period of 6–20 days (Heymann, 2008). Pertussis symptoms start with a catarrhal phase which is followed by a cough, often irritating, over 1–2 weeks which gradually becomes paroxysmal in nature. The coughing paroxysms are followed by a characteristic inspiratory ‘whoop’ and sometimes vomiting. However, in infants, the whoop may not be present and instead the paroxysmal cough is followed by periods of apnoea (Hawker et al, 2005). The cough can be prolonged over several weeks or even months—in China, pertussis is known as ‘the cough of 100 days’ (Carbonetti, 2007).
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