Strains resistant to antibiotics
Children and infants are most at risk of developing a severe form of the disease. “In young children, notable complications are pneumonia or
neurological conditions
(convulsive seizures, encephalitis). In infants, whooping cough can be
very serious or even fatal because it is accompanied by respiratory or multi-organ failure,” underlines the Pasteur Institute. Concerning the current epidemic outbreak, “several cases of serious whooping cough in infants have been observed, requiring intensive care treatment”.
In addition, while macrolides are the antibiotics of choice for the treatment of whooping cough, two resistant strains were identified in France in February and April 2024. Until now, only one strain had been identified, in 2011. “Resistance of B. pertussis to these antibiotics is very high in Asian regions (particularly in China), but remains rare outside this area,” specifies the CNR.
“Great vigilance is therefore required in the monitoring, diagnosis and management of patients presenting symptoms suggestive of whooping cough as well as contact persons. It is also crucial to report grouped cases or clusters to the Regional Health Agencies in charge, and to put in place management and preventive measures,” concludes the CNR in its publication.
A very contagious disease
Respiratory infection caused mainly by the bacteria Bordetella pertussis, the disease is extremely contagious. In fact, an infected person transmits the disease to 15 individuals on average, through the air, during direct contact. In France, while the vaccine has been compulsory for infants since January 1, 2018, contamination mainly occurs from adults or adolescents – in whom booster shots have not been given – to infants who have not yet been vaccinated.
As a reminder, an injection at two months and one at four months of life is mandatory, followed by a booster at 11 months, another at 6 years, then between 11 and 13 years. For adults, a booster is planned at age 25 and offered until age 39, if it has not been completed. In order to protect newborns before the first injection, the High Authority for Health recommends vaccination in pregnant women from the second trimester of pregnancy, favoring the period between 20 and 36 weeks of amenorrhea. Objective: to increase the passive transfer of maternal antibodies across the placenta and thus ensure optimal protection of the newborn thanks to the mother’s antibodies.
Violent coughing fits
In the event of infection, the incubation phase is followed by rhinorrhea (runny nose) which can last two weeks. Then comes the paroxysmal phase characterized by a persistent cough lasting more than 7 days. Coughing fits are associated with difficult inspiratory recovery and may be followed by vomiting. “In infants, apnea can occur, sometimes accompanied by bradycardia (heart rate below normal), or even attacks of cyanosis (bluish discoloration of the skin) during fits. In adolescents and adults, a nocturnal resurgence is observed in the majority of cases,” notes the Institut Pasteur.
Once the diagnosis is confirmed by biological tests, treatment is based on taking antibiotics from the macrolide family. The treatment is also prescribed to all people close to the patient if they have not received a booster vaccination in the last five years.
The trend of increasing cases of whooping cough is identical in several European countries, with significant epidemics notably in Croatia, Denmark and the United Kingdom. According to Public Health France, there are 40 million cases and 300,000 deaths linked to whooping cough each year worldwide.
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