Question
Prophylaxis of whooping cough
Answer
Whooping cough (pertussis, caused by Bordetella pertussis) prophylaxis combines active immunization with chemoprophylaxis and general public-health measures.
Active immunization: DPT vaccine (diphtheria-pertussis-tetanus) as part of the routine childhood immunization schedule — a primary series of 3 doses in infancy, with booster doses at 18 months and 5 years; acellular pertussis vaccine (aP), containing purified pertussis antigens (e.g., pertussis toxoid, filamentous haemagglutinin), is preferred over the older whole-cell vaccine (wP) in many countries due to a better reactogenicity profile, though wP may confer somewhat longer-lasting immunity. A Tdap booster during pregnancy (ideally in the third trimester) is recommended to protect the neonate via passive transfer of maternal antibody across the placenta, covering the vulnerable period before the infant completes their own primary vaccination series.
Chemoprophylaxis: macrolide antibiotics (azithromycin, erythromycin, or clarithromycin) given to close household/institutional contacts of a confirmed case, especially unimmunized/incompletely immunized infants and pregnant women, to reduce secondary transmission — most effective when given early, within 21 days of exposure.
General measures: early identification and isolation of cases (droplet precautions) during the catarrhal and early paroxysmal stage (most infectious period); public health surveillance and outbreak response; health education about the importance of timely vaccination, particularly given waning immunity in adolescents/adults, which contributes to ongoing circulation and infant exposure (“cocooning” strategy — vaccinating close contacts of newborns).