Anti-epidemic measures in the outbreak. Hygienic education and training of citizens in the prevention of pertussis infection

WHOOPING COUGH

Whooping cough is an acute respiratory infectious disease of an anthroponotic nature, characterized by intoxication and a predominant lesion of the respiratory tract with peculiar bouts of convulsive cough.

Etiology. Whooping cough is caused by Bordetella pertussis. It is a representative of the genus Bordetella, belonging to genera with an unclear systematic position. The genus also includes B.parapertussis, and B.bronchiseptica. This is an immobile microorganism with dimensions of 0.2-0.3x0.5-1.2 microns, gram-negative, strict aerobe. It does not form spores; when stained according to Romanovsky-Giemsa, a delicate capsule is revealed, which may be lost during re-sowing. There are three serotypes of the pathogen: 1,2,3; 1,2,0; 1.0.3, as well as "defective" - 1.0.0, the specificity of which is determined by agglutinins. A total of 8 agglutinins are isolated, of which 1 and 7 are common to all serotypes. The serotype with the antigenic set 1,2,3 is more pathogenic and causes severe forms of the disease. In addition to agglutinins, the antigenic structure of the whooping cough pathogen includes hemagglutinin, toxin, lymphocytosis-stimulating and histamine-sensitizing factors, adenylcyclase, and a protective factor. Pertussis microbe toxin is represented by two fractions - exo- and endotoxin. The exotoxin is thermolabile, acts on the pressor nerves, causing vasoconstriction and tissue necrosis, and has immunogenic properties. It is strongly associated with the cell, its maximum amount is found in the logarithmic period of the growth phase, it is not detected in dying cells. Endotoxin is formed during the destruction of microbial cells, does not have immunogenic properties. Both fractions of the toxin have a dermatonecrotizing effect.

The causative agent is unstable in the external environment and quickly dies outside the body. In dry sputum, it remains viable for several hours, in a drop aerosol - 20-23 hours. The whooping cough stick dies when exposed to scattered sunlight within 2 hours, direct sunlight - within 1 hour, ultraviolet rays - within a few minutes. A temperature of 56°C causes the death of the whooping cough pathogen in 10-15 minutes, solutions of disinfectants in normal concentrations - in a few minutes.

The mechanism of development of the epidemic process. source of infection. The source of infection is a patient with an acute form of the disease, which becomes contagious with the appearance of the first clinical manifestations. The contagiousness of the patient is maximum in the catarrhal period and in the first week of convulsive cough, when pertussis can be isolated in 90-100% of cases. In the second week of spasmodic cough, the pathogen is isolated in 60-70% of cases, from the third week the patient's infectivity decreases sharply. As a rule, after the 25th day of illness, the pathogen cannot be isolated. The quality of etiotropic therapy also affects the duration of the infectious period. All patients with whooping cough, regardless of the severity of clinical manifestations, are dangerous as sources of the infectious agent. Of particular danger are patients with erased atypical forms of whooping cough, whose importance has increased sharply after the introduction of active immunization. It should be noted that in most cases the diagnosis is made after the onset of a convulsive cough, and patients in the prodromal period remain in groups, actively infecting others. The carriage of whooping cough in the foci of infection was established. Carriage occurs infrequently - in 1-2% of older children who are vaccinated against whooping cough and have strained immunity, as well as in adults caring for children (up to 10-12%). Carriage occurs only in affected institutions and does not occur in institutions where there are no sick children. Carriage, as a rule, is short - does not exceed two weeks and does not have significant epidemiological significance.

transmission mechanism. The causative agent of whooping cough is transmitted through an airborne mechanism. . The pertussis bacillus multiplies only in the deep sections of the respiratory tract (larynx, trachea, bronchi) and is excreted from the body with the secret of the respiratory tract during coughing and other expiratory acts. The patient, when coughing, throws out a coarse aerosol into the environment, which settles in the immediate vicinity of the source of infection. Infection occurs only through direct contact with the source of infection at a distance not exceeding 2 meters. Thus, close and prolonged contact with the patient is necessary for the spread of infection. Due to the pronounced instability of the pathogen in the environment, the transmission of whooping cough through contaminated household items or third parties is practically excluded.

susceptibility and immunity. Children are susceptible to whooping cough from the first days of life. Maternal antibodies are practically absent in the blood of newborns, regardless of their presence in the mother's blood. This is due to the fact that anti-pertussis antibodies are mainly represented by class M immunoglobulins, which do not cross the placenta. Currently, there are reports of the detection of maternal antibodies in the blood of newborns during the first 5-6 weeks of life, but this does not protect them from infection. The first encounter with the pathogen usually leads to the development of a clinically significant disease. Such a meeting occurs most often in early childhood, which determines the "childish" nature of the infection. The protective factor is determined only in a living microbial cell and is an antigen that ensures the formation of stable lifelong immunity in whooping cough survivors. Repeated diseases are extremely rare and are apparently due to the early prescription of antibiotics, which not only leads to effective relief of the process, but also prevents the formation of stable immunity. The cell-based pertussis vaccine, which is currently used in most countries of the world, lacks a protective factor, which leads to the development of inadequate immunity.

Main clinical manifestations. The incubation period for whooping cough ranges from 4 to 21 days, averaging 5-8 days. In the pre-vaccination period, pertussis had a severe course and was characterized by high rates of mortality and mortality. So, in 1890, in the Minsk province, the mortality rate for whooping cough was 8.32%. According to these indicators, whooping cough ranked 1st among the causes of death in children in the first year of life. This is explained by the fact that whooping cough was often accompanied by severe complications, the main of which was pneumonia, which complicated the course of the disease in 70-80% of cases. Currently, mild and erased forms of the disease predominate - up to 95%. Moderate forms occur in a small number of patients, some children are bacterial carriers.

Children of the first year of life endure whooping cough is still difficult, since the phenomenon of passive immunity in this infection is not expressed. They still often have complications in the form of pneumonia (up to 10% of cases) and bronchitis (40-45% of cases).

During pertussis infection, the following consecutive periods are distinguished: incubation, catarrhal, spasmodic cough, regression or resolution. The catarrhal period is characterized by persistent cough, lasts from 3 to 14 days and is the most contagious. The spasmodic or convulsive period is characterized by coughing fits with reprisals and lasts from 2 to 4 weeks (in infants it can increase up to 2-3 months). The total duration of pertussis infection depends on the severity of the course of the disease, but usually does not exceed 6-8 weeks. Adults also suffer from whooping cough, but they do not have severe forms of the disease. In adults, mild (about 65%) and erased (up to 20% of cases) forms of the disease predominate. There are significantly more bacteria carriers among adults who have been in contact with whooping cough patients than among children - 10-12% versus 1-2%, respectively.

Laboratory diagnostics. The diagnosis of whooping cough is based on clinical and epidemiological data and laboratory results. Any person who coughs for a long time, whether a child or an adult, is suspicious of whooping cough, especially if they have had active immunizations in the past.

The main method of laboratory diagnostics is bacteriological. The material for the study is mucus from the posterior pharyngeal wall. which is taken on an empty stomach or 2-3 hours after a meal. Taking the material can be carried out in two ways: by the method of "tampon" and "cough plates". Due to the slow growth of whooping cough on nutrient media, bacteriological examination continues for 5-7 days, i.e. a preliminary response can be obtained on the 3rd-5th day, the final one - on the 5th-7th day. Currently, an immunofluorescent method has been proposed (as a method of express diagnostics), which allows you to get a response 2-6 hours after sampling. The antigen is mucus from the larynx, and the antibody is dry luminescent pertussis globulins from hyperimmune antibacterial sera of donkeys. With a prolonged cough and the absence of bacteriological confirmation of the diagnosis, a serological diagnostic method is used. The agglutination reaction (RA), the complement fixation reaction (RCC) and the passive hemagglutination reaction (RPHA) are used. Serological examination should be carried out in dynamics, starting from the second - third week of illness with an interval of 1-2 weeks. An increase in antibody titers by 4 or more times is of diagnostic value. For children who have not been vaccinated and have not previously had whooping cough, the presence of specific antibodies in titers of 1:80 and above is of diagnostic significance.

Manifestations of the epidemic process. In the pre-vaccination period of pertussis infection in the Republic of Belarus, the intensity of the epidemic process was characteristic in the range from 120.0 to 320.0 cases per 100,000 of the population, cyclicity at intervals of 3-4 years, high foci, a pronounced prevalence of morbidity among children attending children's institutions, more higher incidence in cities than in rural areas. Globally, more than 80% of cases were children under five years of age, with children under 3 accounting for about 50% of all reported cases.

In 1958, whooping cough immunoprophylaxis was started. Until the beginning of the 1960s, the pertussis-diphtheria vaccine was used, then KDS-, and even later, DPT-vaccine. In the first years of immunization, vaccination coverage was small and did not have a significant impact on the course of the epidemic process. However, since 1964 there has been a pronounced decrease in the incidence (up to 77.4-12.1 cases per 100,000), and since 1978, the incidence of pertussis does not exceed 2-8 cases per 100,000 of the population.

The increase in the level of vaccination was accompanied by a change in the etiological structure and properties of the pathogen. Until the 1970s, serovar 1,2,3 dominated, characterized by high virulence (LD50 - 3.579 MMU). Since the late 1970s, the toxicity and virulence of circulating strains has decreased. In the 70-80s in the etiological structure of the pathogen, 93% was serovar 1.0.3, characterized by relatively low virulence (LD50 - 6.555 MEM).

In the long-term dynamics, cyclicity with intervals of 3-4 years has been preserved. It is explained by a change in the virulence of circulating pathogens, an increase in which is inevitable with the accumulation of a layer of susceptible individuals. Seasonality is not clearly expressed and differs somewhat from seasonality in other aerosol infections: the rise in incidence begins already in summer and reaches a maximum in the autumn-winter period. The age structure of morbidity has also changed. At present, children of the first year of life are in the most unfavorable conditions. The share in the structure of sick children and adolescents aged 7-14 also increased. The incidence of children attending a nursery is significantly lower than the incidence of children at home, which may be due to the higher immunization coverage of organized children.

epidemiological surveillance. The purpose of epidemiological surveillance of whooping cough is to prevent diseases in risk groups and reduce the incidence of the population.

To assess the epidemic situation of whooping cough, one should have information on the incidence of this infection in past years and at the present time. In addition, information reflecting the timeliness and completeness of vaccination coverage of persons subject to vaccination and revaccination is important; the results of quality control of incoming vaccines and the conditions of their storage, transportation and use; data of laboratory examination of patients and persons suspected of having whooping cough.

As a result of the analysis of information, the most typical manifestations of the epidemic process are revealed, the quality and effectiveness of the preventive and anti-epidemic measures taken are evaluated. Based on the data obtained, management decisions are made on the implementation of preventive measures.

Prevention. The basis for the prevention of whooping cough is the active immunization of children with adsorbed pertussis-diphtheria-tetanus vaccine (DPT-vaccine). Immunization is carried out from the age of three months. The pertussis component of the DPT vaccine (killed pertussis bacteria) causes the production of immunity, which in some cases does not prevent the development of the disease. However, in those vaccinated with this vaccine, whooping cough is mild and without complications. In recent years, in some countries, acellular pertussis vaccine has been used for pertussis vaccination, which is a low reactogenic and effective drug.

Anti-epidemic measures. A person with whooping cough must be isolated. Hospitalization is carried out according to clinical and epidemic indications. Isolation of patients continues for 25 days from the onset of the disease. Persons who have been in contact with whooping cough patients are subjected to a medical examination, epidemiological history taking and medical observation. In groups serving children under 3 years of age, in order to actively identify sources of infection, a double bacteriological examination of children and staff is carried out. Cough is the main symptom of whooping cough. Therefore, in order to identify the sources of infection of each child who coughs for 5-7 days, the doctor should send him for a double bacteriological examination (two days in a row or every other day) and establish active monitoring of him. Coughing children are examined in a special room of the clinic or at home. Adults working with children are examined in the bacteriological laboratory of the CGE or in the outbreak of whooping cough at the place of work. Identified carriers from these groups are isolated until two negative results of bacteriological examination are obtained, carried out 2 days in a row or with an interval of 1-2 days.

If children under 7 years of age who did not get sick and were not vaccinated against this infection communicated with sick whooping cough at the place of residence, then they are subject to separation from organized groups for 14 days. For children who have been ill or vaccinated under 7 years of age, as well as children over 7 years of age and adults who have been in contact with sick whooping cough, medical supervision is established for 14 days without separation from the teams. In the family and apartment, as well as in closed children's groups, communicating with children under 7 years of age and adults working with children of preschool age, a double bacteriological examination is performed.

The causative agent of whooping cough has a low resistance in the external environment, so the final disinfection in the foci of this infection is not carried out. In the outbreaks of whooping cough, it is necessary to strengthen the observance of sanitary and hygienic measures (wet cleaning, ventilation, processing of toys), as well as the conduct of sanitary and educational work.

7.1. The purpose of anti-epidemic measures in the focus of pertussis infection is its localization and elimination.

7.2. Primary anti-epidemic measures in outbreaks are carried out by medical workers of medical and other organizations, as well as persons who have the right to engage in private medical practice and who have received a license to carry out medical activities in accordance with the procedure established by the legislation of the Russian Federation, immediately after a patient is identified or whooping cough is suspected.

7.3. Upon receipt of an emergency notification, specialists of the territorial bodies of the federal executive body authorized to exercise federal state sanitary and epidemiological supervision, within 24 hours, conduct an epidemiological investigation of the focus of infection in preschool educational and general educational organizations, special educational and educational institutions of open and closed type, recreation organizations children and rehabilitation, organizations for orphans and children left without parental care, orphanages, sanatoriums for children, children's hospitals, maternity hospitals (departments) to determine the source of infection, clarify the boundaries of the focus, the circle of people who were in contact with the sick person, their vaccination status, as well as monitor the implementation of anti-epidemic and preventive measures in the outbreak.

7.4. In the focus of pertussis infection, prophylactic vaccinations against whooping cough are not carried out.

In the room, daily wet cleaning is carried out using disinfectants approved for use, and frequent airing.

7.5. Children under the age of 14 who have been in contact with a sick whooping cough, regardless of their vaccination history, are subject to suspension from attending preschool educational and general educational organizations. They are admitted to the children's team after receiving two negative results of bacteriological and (or) one negative result of molecular genetic studies.

7.6. In family (families with whooping cough) outbreaks, contact children are placed under medical supervision for 14 days. All coughing children and adults undergo a double bacteriological (two days in a row or with an interval of one day) and (or) a single molecular genetic study.

7.7. Adults working in pre-school educational and general educational organizations, special educational and educational institutions of open and closed type, children's recreation and rehabilitation organizations, organizations for orphans and children left without parental care, children's homes, sanatoriums for children, children's hospitals, maternity houses (departments) who have been in contact with a patient with whooping cough at the place of residence / work, in the presence of a cough, are subject to suspension from work. They are allowed to work after receiving two negative results of bacteriological (two days in a row or with an interval of one day) and (or) one negative result of molecular genetic studies.

7.8. For persons who had contact with patients with whooping cough in preschool educational and general educational organizations, special educational and educational institutions of an open and closed type, children's recreation and rehabilitation organizations, organizations for orphans and children left without parental care, children's homes, sanatoriums for children, children's hospitals, maternity hospitals (departments), medical supervision is established within 14 days from the date of termination of communication. Medical supervision of those who communicated with the patient with daily examination of contacts is carried out by medical personnel of the medical organization to which this organization is attached.

In preschool educational and general educational organizations, special educational institutions of open and closed type, children's recreation and rehabilitation organizations, organizations for orphans and children left without parental care, orphanages, sanatoriums for children, children's hospitals, maternity hospitals (departments ) in case of occurrence of secondary cases of the disease, medical observation is carried out until the 21st day from the moment of isolation of the last sick person.

7.9. Newborns in maternity hospitals, children of the first 3 months of life and unvaccinated children under the age of 1 year who had contact with whooping cough are injected intramuscularly with normal human immunoglobulin in accordance with the instructions for the drug.

Quarantine for whooping cough lasts a certain time, which depends on the presence of immunity to the pathogen.

If a source of damage is found among the children, then from that moment on, it is recommended that all those who contacted be excluded from the team for a period of 14 to 16 days. In the case when a child with whooping cough remains in the group, general isolation is carried out for 25 days.

Why quarantine for whooping cough? What is used to prevent infection? To fully understand the picture, consider the main signs and features of the influence of infection on humans.

Whooping cough disease has a feature that manifests itself in acute damage to the respiratory tract. This is a bacterial infection transmitted by airborne droplets, which is determined by the presence of the pathogen - pertussis bacillus called Bordetella pertussis.

Most often, young children from 2 to 7 years old get sick. This is due to maternal immunity, which is transmitted from birth until the end of breastfeeding. The mass accumulation of babies causes the rapid transmission of whooping cough. But for a childhood infection, an average or mild form of the course is characteristic.

A specific symptom of a bacterial infection is a severe spasmodic cough that appears 2 weeks after infection (the day when quarantine is established). But, in addition, before the acute phase of the disease, during the catarrhal period of whooping cough, such signs as:

inflammation of the nasopharynx - runny nose, sneezing;
moderate temperature - increase in readings to 38-38.5 C;
cough - turning into seizures.

In addition, with whooping cough, the cells of the nervous system are affected, as a result of which the child becomes irritable and capricious.

In infants, the presence of signs of a bacterial infection with whooping cough carries a danger in the form of respiratory arrest, when coughing spasms lead to impaired lung function. As a result, the baby may die.

In almost every case of whooping cough, immediate antibiotic therapy is required. Then the doctor prescribes a complex of drugs that can prevent the onset of an acute manifestation of the infection in the form of serious and severe coughing attacks. Such treatment is often carried out even before an accurate diagnosis is confirmed, since laboratory studies of the patient's tissues take several days. In this case, a person with signs of bacterial whooping cough is sent to quarantine.

During the treatment of any form of the disease, it is very important to create the right conditions for recovery, which really help to cope with ailments:

provide the patient with peace, exclude external (sound, light) stimuli;
prescribe a sparing diet with a high protein content - food should not be too spicy, sour or dry, as this can provoke another coughing fit;
regularly ventilate the room, walk in the fresh air;
comply with prescribed medications;
drink more liquid (compotes, teas with raspberries, linden).

It is good, along with medications, to use folk remedies to relieve coughing. One of these effective methods is as follows: they take a handful of dry mustard and put it in the socks that the child puts on.

A wool compress soaked in a mixture of fir oil, table vinegar and camphor will also be very effective. Subject to bed rest, it is placed on the child's chest for warming.

The first and main preventive measure for whooping cough is the isolation of the patient from the team for a period of 14-16 days. If the child's disease is severe or with complications, then hospital treatment is recommended. Quarantine for whooping cough can be extended up to 25 days from the onset of the first signs of infection in the group.

Upon contact with an infectious person, sick preschool children should be temporarily quarantined. For prevention purposes, vaccination with immunoglobulin is carried out for those who have not been previously vaccinated with DTP. The cell-free vaccine consists of three injections, which are administered once with a break of 1-3 months. It contains protection against whooping cough, diphtheria and tetanus, and today is considered the most effective means of preventing whooping cough. The vaccine is given to children under the age of 5 months by subcutaneous method. In the future, to support immune protection, revaccination will be required.

To diagnose the disease at an early stage, and to exclude mass infection, at the first sign of whooping cough, it is necessary to conduct a laboratory study. Children of the first months of life, in which the virus usually occurs in a severe form, are at particular risk. In other cases of childhood illness, the prognosis is favorable. The following patients are subject to mandatory hospitalization in the initial stage of whooping cough:

children under one year old who did not have a bacterial infection;
patients under 3 years old from families with unfavorable living conditions;
the first cases in children's institutions.

Quarantine for whooping cough is 21 days from the last visit to the team by the last infected child.

It turns out that quarantine is extended if someone else gets sick at school or kindergarten. But basically, doctors recommend home treatment for about a month, or even more, since the defenses of a child with whooping cough are especially weakened.

For small children with whooping cough, first of all, a course of vitamin therapy is carried out. Apply drugs such as: Passilat, Mystic, Chromvital + and others. To restore the intestinal microflora after taking potent antibiotics, probiotics are recommended (for example, Linex). From herbal remedies for improving health, tincture of ginseng, Aralia Manchurian or Eleutherococcus is suitable.

In the post-morbid period, which should last at least 2 weeks, the child's lifestyle is very important. To exclude repeated attacks of coughing, you need to walk more, move, and, if possible, reduce negative emotions to a minimum.

whooping cough symptoms

Table of contents of the subject "Epidemiology of Whooping Cough. Epidemiology of Streptococcus.":

When whooping cough sick children are subject to isolation from children's institutions. Admission to the team is carried out after the course of etiotropic therapy. The remaining groups of the population from among the patients are isolated according to clinical indications.

With regard to those who spoke with whooping cough children up to 7 years quarantine is provided for a period of 14 days. Children under the age of 7 who are in contact with the sick person, as well as employees of maternity hospitals, children's hospitals, sanatoriums and caregivers of children's institutions are subject to observation and bacteriological examination for whooping cough.

In modern conditions whooping cough prevention provided by active immunization. In Russia, specific prophylaxis is carried out with the help of an associated drug - adsorbed pertussis-diphtheria-tetanus (DTP) vaccine. Vaccinations are carried out from the age of three months by three injections of the drug with an interval of 1.5 months. At 18 months, a single revaccination is carried out.

Pertussis component of the DTP vaccine has sufficient reactivity; after vaccinations, both local and general reactions are observed. Registered reactions of a neurological nature, which are a direct consequence of vaccinations. These circumstances have led to the fact that pediatricians are very careful about administering DTP vaccinations, this explains the large number of unreasonable medical challenges.

Reactogenicity of killed pertussis vaccine led to the fact that in some countries (Japan, Sweden, Great Britain) they generally refused vaccinations, which immediately led to a sharp increase in the incidence. At the same time, a lot of new scientific data appeared in the world, which significantly expanded the general idea of pertussis infection and its causative agent, in particular, the role and significance of individual antigens in the formation of protection against whooping cough. The concept of the leading role of pertussis toxin in the pathogenesis of infection was proposed.

Not the last role in the formation whooping cough protection belongs to filamentous heme-agglutinin, agglutinogens 2, 3, 69KDe protein (pertactin). At the end of the XX century. in different parts of the world (Australia, North America, Western Europe) an increase in the incidence of whooping cough was recorded against the background of the mass use of the DPT vaccine, while a drift of protective antigens of 5. pertussis (pertactin, S\ and pertussis toxin subunits) was detected. According to experts, the drift is due to the influence of post-vaccination immunity, and the resulting changes in protective antigens in new strains are so significant that vaccines from the "old" strains are not effective. In this regard, constant monitoring of circulating strains is necessary.

Given the new concept, first in Japan, and then in the USA and Sweden, a acellular pertussis vaccine, based on pertussis toxin and new protection factors. In Russia, work is also underway to create a cell-free pertussis vaccine.

CHIEF STATE SANITARY PHYSICIAN OF THE RUSSIAN FEDERATION

RESOLUTION

On approval of SP 3.1.2.3162-14

In accordance with the Federal Law of March 30, 1999 N 52-FZ "On the sanitary and epidemiological well-being of the population" (Collected Legislation of the Russian Federation, 1999, N 14, art. 1650; 2002, N 1 (part I), art. 2; 2003, N 2, item 167; N 27 (part I), item 2700; 2004, N 35, item 3607; 2005, N 19, item 1752; 2006, N 1, item 10; N 52 (Part I), Art. 5498; 2007 N 1 (Part I), Art. 21; N 1 (Part I), Art. 29; N 27, Art. 3213; N 46, Art. 5554; N 49, art. 6070; 2008, N 24, art. 2801; N 29 (part I), art. 3418; N 30 (part II), art. 3616; N 44, art. .I), article 6223; 2009, N 1, article 17; 2010, N 40, article 4969; 2011, N 1, article 6; N 30 (part I), article 4563; N 30 ( Part I), Art. 4590; N 30 (Part I), Art. 4591; N 30 (Part I), Art. 4596; N 50, Art. 7359; 2012, N 24, Art. 3069; N 26, Art. 3446; 2013, N 27, Art. 3477; N 30 (Part I), Art. 4079) and Decree of the Government of the Russian Federation of July 24, 2000 N 554 "On Approval of the Regulations on the State Sanitary and Epidemiological Service of the Russian Federation and Regulations on State Sanitary and Epidemiological Rationing" (Collected Legislation of the Russian Federation, 2000, N 31, Art. 3295; 2004, N 8, article 663; N 47, art. 4666; 2005, N 39, art. 3953)

I decide:

1. Approve the sanitary and epidemiological rules SP 3.1.2.3162-14 "Whooping cough prevention" (Appendix).

2. Recognize invalid the decision of the Chief State Sanitary Doctor of the Russian Federation dated April 30, 2003 N 84 "On the Enactment of Sanitary and Epidemiological Rules SP 3.1.2.1320-03" ("Pertussis Infection Prevention", registered by the Ministry of Justice of the Russian Federation on May 20, 2003 , registration N 4577).

Acting Chief
state sanitary doctor
Russian Federation
A. Popova

Registered
at the Ministry of Justice
Russian Federation
June 19, 2014
registration N 32810

Sanitary and epidemiological rules SP 3.1.2.3162-14 "Whooping cough prevention"

Sanitary and epidemiological rules SP 3.1.2.3162-14

I. Scope

1.1. These Sanitary Rules establish requirements for a set of organizational, therapeutic and prophylactic, sanitary and anti-epidemic (preventive) measures taken to prevent the occurrence and spread of whooping cough.

1.2. Compliance with sanitary rules is mandatory for citizens, legal entities and individual entrepreneurs.

1.3. Control over the implementation of these sanitary rules is carried out by bodies authorized to exercise federal state sanitary and epidemiological supervision.

II. General provisions

2.1. Whooping cough is characterized by a prolonged spasmodic cough, damage to the respiratory, cardiovascular and nervous systems. The aerosol mechanism of transmission of infection, which is realized by airborne droplets, is involved.

Sources of infection are patients (children and adults) with typical and atypical forms of whooping cough. The transmission of the infectious agent is carried out through the air by means of droplets of mucus secreted by the patient during increased exhalation (loud talking, screaming, crying, coughing, sneezing). The most intense transmission of the pathogen occurs when coughing. The risk of infecting others is especially high at the beginning of the spasmodic period, then it gradually decreases and, as a rule, by the 25th day, a person with whooping cough becomes non-infectious. The incubation period ranges from 7 to 21 days. Bacteriocarrier in whooping cough does not play a significant epidemiological role.

Susceptibility to whooping cough remains high in children under 1 year of age, in persons who have not been vaccinated against whooping cough, and in those who have lost immunity to whooping cough infection with age.

2.2. The characteristic clinical manifestations and hematological changes in whooping cough include:

- subacute onset of the disease with the appearance of an unproductive cough within 3-14 days in the absence of an increase in body temperature and catarrhal phenomena of the upper respiratory tract;

- spasmodic paroxysmal prolonged cough with flushing or cyanosis of the face, lacrimation, reprises, vomiting, breath holding, apnea, clear sputum discharge, aggravated at night, after physical or emotional stress;

- formation of "pertussis lung", characterized by signs of emphysema, productive inflammation in the perivascular and peribronchial tissue;

- leukocytosis and lymphocytosis.

2.3. When making a diagnosis, take into account:

- characteristic clinical manifestations;

- the results of laboratory studies, including the isolation of the culture of the pathogen during bacteriological examination or the DNA of the pathogen during molecular genetic testing, or the detection of specific antibodies during serological testing in enzyme immunoassay (ELISA);

- epidemiological history data (vaccination status and the patient's contact with whooping cough).

All cases of bacteriocarrier of the whooping cough pathogen are diagnosed on the basis of the results of the isolation of the culture of the pathogen or the DNA of the pathogen.

2.4. Classification of whooping cough cases:

- "suspicious" is a case in which there are clinical signs of whooping cough listed in clause 2.2 of these rules;

- “probable” is a case in which there are characteristic clinical signs and an epidemiological link with another suspected or confirmed case has been identified;

- "confirmed" is a case of whooping cough previously classified as "suspicious" or "probable" after laboratory confirmation (with isolation of the culture of the pathogen or DNA of the pathogen, or specific anti-pertussis antibodies).

In the absence of laboratory confirmation of the diagnosis, a "probable" case is classified as "confirmed" on the basis of clinical findings (manifestations).

In case of atypical forms of the disease, a laboratory-confirmed case of whooping cough does not have to have the clinical manifestations specified in clause 2.2 of these rules.

The final diagnosis is established:

- clinically - on the basis of the characteristic symptoms of the disease in the absence of the possibility of laboratory diagnostics or with negative results of a laboratory test;

- to confirm the preliminary diagnosis by laboratory methods (isolation of the culture or DNA of the pathogen, or anti-pertussis antibodies);

- based on the characteristic symptoms of the disease, taking into account the presence of an epidemiological relationship with the source of infection.

2.5. The diagnosis of parapertussis and bronchisepticosis, given the similarity of clinical manifestations with whooping cough, is established on the basis of isolation of the culture or DNA of the corresponding pathogen.

2.6. Immunity to whooping cough is formed after an illness or after immunization against this infection. An indicator of the presence of immunity to whooping cough is the presence in the blood of specific immunoglobulins (antibodies) of class G.

III. Identification of patients with whooping cough and persons with suspected disease

3.1. Identification of patients with whooping cough and persons suspected of having this disease is carried out by medical workers of medical and other organizations, as well as persons who have the right to engage in private medical practice and have received a license to carry out medical activities in accordance with the procedure established by the legislation of the Russian Federation, in the following cases:

- in the provision of all types of medical care, including at home;

- during periodic and preliminary preventive medical examinations;

- during medical supervision of persons who have been in contact with patients with whooping cough;

- when conducting laboratory tests for diagnostic purposes and according to epidemic indications.

3.2. In order to detect whooping cough early, health workers send:

- each child coughing for 7 days or more - for a double bacteriological (two days in a row or every other day) and (or) a single molecular genetic study, and also establish medical supervision for him;

- each adult with suspected whooping cough and / or in the presence of contact with a sick whooping cough, working in maternity hospitals, children's hospitals, sanatoriums, preschool educational and general educational organizations, special educational and educational institutions of open and closed type, organizations for children's recreation and their rehabilitation, organizations for orphans and children left without parental care - for a double bacteriological (two days in a row or every other day) and (or) a single molecular genetic study.

3.3. For differential diagnosis in clinically unclear cases and in the absence of detection of the pathogen using bacteriological and molecular genetic research methods, children and adults should be examined twice with an interval of 10-14 days by ELISA.

IV. Registration and registration of patients with whooping cough

4.1. In case of detection of patients with whooping cough (or if whooping cough is suspected), medical workers of medical and other organizations, persons who have the right to engage in private medical practice and have received a license to carry out medical activities in accordance with the procedure established by the legislation of the Russian Federation, are obliged to report this within 2 hours by telephone and within 12 hours send an emergency notice to the territorial body of the federal executive body authorized to exercise federal state sanitary and epidemiological surveillance at the place where the patient was detected (regardless of his place of residence).

4.2. The medical organization that changed or clarified the diagnosis, within 12 hours, submits a new emergency notification for this patient to the territorial body of the federal executive body authorized to exercise federal state sanitary and epidemiological surveillance, indicating the initial diagnosis, the changed (clarified) diagnosis, the date of its establishment and, if available, laboratory test results.

4.3. The territorial body of the federal executive body authorized to exercise federal state sanitary and epidemiological surveillance, upon receipt of a notice of a changed (specified) diagnosis, informs the medical organization at the place of detection of the patient that submitted the initial emergency notice.

4.4. Each case of whooping cough is subject to registration and recording in the register of infectious diseases at the place of their detection, as well as in the territorial bodies of the federal executive body authorized to carry out federal state sanitary and epidemiological surveillance.

4.5. Registration, accounting and statistical observation of cases of whooping cough is carried out.

4.6. Responsibility for the completeness, reliability and timeliness of registration and accounting of cases of diseases (suspicions of a disease) with whooping cough, as well as the prompt and complete informing of the territorial body of the federal executive body authorized to exercise federal state sanitary and epidemiological surveillance, is borne by the head of the medical organization at the place identification of the patient.

4.7. Upon receipt of an emergency notification of a case of whooping cough (suspicion of this disease), a specialist of the territorial body of the federal executive body authorized to exercise federal state sanitary and epidemiological supervision conducts an epidemiological investigation by filling out an epidemiological investigation card.

V. Laboratory diagnosis of whooping cough

5.1. For laboratory diagnosis of whooping cough, bacteriological, serological and molecular genetic research methods are used. The choice of method is determined by the duration of the disease.

The bacteriological method is used in the early stages of the disease in the first 2-3 weeks, regardless of the use of antibiotics.

The serological method (ELISA) must be applied from the 3rd week of illness. By decision of the attending physician, a second blood test is performed after 10-14 days.

The molecular genetic method is used at any time from the onset of the disease, regardless of the patient's antibiotic therapy. The molecular genetic method is most effective in young children.

5.2. The collection and transportation of pathological material for laboratory diagnosis of whooping cough is carried out in accordance with the established procedure (Appendix 1 to these sanitary rules).

5.3. Bacteriological examination is carried out in accordance with regulatory documents.

Molecular genetic testing is carried out using reagent kits registered and approved for use on the territory of the Russian Federation in accordance with the procedure established by law, according to the instructions for their use.

5.4. Serological diagnosis of whooping cough is carried out by ELISA using reagent kits to determine the level of specific anti-pertussis antibodies of the IgM, IgA, IgG classes, registered and approved for use on the territory of the Russian Federation in accordance with the procedure established by law. The interpretation of the results of the ELISA is set out in Appendix 2 to these sanitary rules.

A negative serological test result does not rule out infection with whooping cough. The results of serological studies are interpreted in conjunction with the clinical picture of the disease.

VI. Measures regarding the source of infection

6.1. Patients with whooping cough, persons with suspected whooping cough, depending on the severity of the clinical course, medical care is provided in a hospital or at home. When they are treated at home, they are under medical observation.

6.2. Hospitalizations are subject to:

6.2.1. According to clinical indications:

- children of the first 6 months of life;

- children older than 6 months with a pronounced severity of the course of the disease, an altered premorbid state, concomitant diseases (perinatal encephalopathy, convulsive syndrome, profound prematurity, malnutrition of II-III degree, congenital heart disease, bronchial asthma), simultaneous occurrence of whooping cough and acute respiratory viral, and also other infections, complications of pertussis infection (pneumonia, encephalopathy, encephalitis, subcutaneous emphysema, pneumothorax);

- adults with complicated course.

6.2.2. According to epidemic indications:

- children from educational institutions with round-the-clock stay of children, orphanages, organizations for orphans and children left without parental care;

- living in hostels (according to indications).

6.3. Children with whooping cough of the first year of life should be placed in boxed departments, older ones in small wards, providing for the isolation of patients with mixed infections.

6.4. In the directions for hospitalization of patients with whooping cough or suspected of having a disease, in addition to personal data, the initial symptoms of the disease, information about preventive vaccinations and contacts with a patient with whooping cough or a bacillicarrier are indicated.

6.5. In the first 3 days of the patient's admission to the hospital, regardless of the prescription of antibiotics, within a period not exceeding 3 weeks from the onset of the disease, a double bacteriological examination for the presence of the whooping cough pathogen and (or) a single molecular genetic study is performed. In cases of admission of the patient to the hospital on the 4-5th week, serological (ELISA) and molecular genetic studies are performed.

6.6. All patients with whooping cough (children and adults) identified in children's hospitals, maternity hospitals, orphanages, pre-school educational and general educational organizations, special educational and educational institutions of open and closed type, organizations for children's recreation and their rehabilitation, organizations for orphans and children, left without parental care are subject to isolation for a period of 25 days from the onset of the disease.

6.7. Bacteriocarriers of the causative agent of pertussis infection from the organizations listed in clause 6.6 of these rules are subject to isolation until two negative results of bacteriological examination are obtained.

6.8. Adults with whooping cough who do not work in organizations listed in paragraph 6.6 of these rules are subject to suspension from work for clinical reasons.

6.9. Bacteriological examination of those who have recovered from whooping cough after treatment is not carried out, except for children hospitalized from orphanages, general educational organizations with round-the-clock stay of children, special educational and educational institutions of a closed type, organizations for orphans and children left without parental care, if there are 2 negative results bacteriological research.

6.10. In the organization of convalescents, whooping cough is allowed in the absence of clinical manifestations.

VII. Activities in the focus of infection

7.1. The purpose of anti-epidemic measures in the focus of pertussis infection is its localization and elimination.

7.4. In the focus of pertussis infection, prophylactic vaccinations against whooping cough are not carried out.

In the room, daily wet cleaning is carried out using disinfectants approved for use, and frequent airing.

7.8. For persons who had contact with patients with whooping cough in preschool educational and general education organizations, special educational and educational institutions of open and closed type, children's recreation and rehabilitation organizations, organizations for orphans and children left without parental care, children's homes, sanatoriums for children, children's hospitals, maternity hospitals (departments), medical supervision is established within 14 days from the date of termination of communication. Medical supervision of those who communicated with the patient with daily examination of contacts is carried out by medical personnel of the medical organization to which this organization is attached.

In preschool educational and general educational organizations, special educational and educational institutions of open and closed type, children's recreation and rehabilitation organizations, organizations for orphans and children left without parental care, orphanages, sanatoriums for children, children's hospitals, maternity hospitals (departments) in the event of secondary cases of the disease, medical observation is carried out until the 21st day from the moment of isolation of the last case.

VIII. Specific prophylaxis for whooping cough

8.1. The main method of prevention and protection of the population against whooping cough is vaccination.

8.2. Immunization of the population against whooping cough is carried out within the framework of the national calendar of preventive vaccinations. For immunization, immunobiological medicinal products approved for use in the Russian Federation are used.

8.3. Preventive vaccinations for minors are carried out with the consent of the parents or other legal representatives of minors after they receive complete and objective information from medical workers about the need for preventive vaccinations, the consequences of refusing them, and possible post-vaccination complications.

8.4. Consent or refusal to carry out preventive vaccination is recorded in medical records and signed by the parent or his legal representative and a medical worker.

8.5. The head of a medical organization ensures the planning, organization and conduct of preventive vaccinations, the completeness of coverage and reliability of their accounting, the timely submission of reports on vaccinations to the territorial body of the federal executive body authorized to exercise federal state sanitary and epidemiological supervision.

8.6. Accounting for the child population, organization and maintenance of a vaccination card file, the formation of a plan for preventive vaccinations is carried out in accordance with applicable law.

8.7. The plan for preventive vaccinations and the need of medical organizations for immunobiological medicines for their implementation are coordinated with the territorial body of the federal executive body authorized to exercise federal state sanitary and epidemiological supervision.

8.8. Medical workers of medical and other organizations, as well as persons who have the right to engage in private medical practice and have received a license to carry out medical activities in accordance with the legislation of the Russian Federation, when carrying out preventive vaccination against whooping cough, register it in their medical records. Information about the vaccination against whooping cough is entered into the accounting documentation and the certificate of preventive vaccinations.

8.9. If a child does not have prophylactic vaccinations against whooping cough, medical workers of organizations find out the reasons why the child was not vaccinated and organize his immunization taking into account the requirements contained in paragraph 8.3. these rules.

8.10. To ensure population immunity to whooping cough, vaccination coverage of the population in the territory of the municipality should be:

- completed vaccination of children aged 12 months - at least 95%;

- the first revaccination of children at the age of 24 months - at least 95%.

8.11. Immunization is carried out by medical personnel trained in vaccination.

IX. Measures to ensure federal state sanitary and epidemiological surveillance

9.1. Measures to ensure federal state sanitary and epidemiological surveillance include:

- monitoring of morbidity;

- control over the coverage of vaccinations and the timeliness of their implementation;

- tracking the immunological structure of the population and the state of population immunity;

- tracking the circulation of the whooping cough pathogen, its phenotypic and genotypic properties;

- monitoring and evaluation of the timeliness and effectiveness of ongoing preventive and anti-epidemic measures;

- assessment of the epidemiological situation in order to make management decisions and predict the incidence.

9.2. In order to assess the state of population immunity to pertussis, studies of the intensity of immunity in vaccinated individuals are carried out.

X. Hygienic education of the population on the prevention of whooping cough

10.1. Hygienic education of the population about the advantages of pertussis vaccine prevention is organized and carried out by the bodies exercising federal state sanitary and epidemiological supervision, health authorities, medical prevention centers, and medical organizations.

10.2. In order to promote the prevention of whooping cough, cultural and educational institutions and the media are used.

Annex 1. Requirements for the collection and transportation of material for the laboratory diagnosis of whooping cough

Annex 1
to SP 3.1.2.3162-14

1. Taking, transporting and laboratory testing of material for whooping cough is carried out in accordance with regulatory documents for laboratory diagnosis of whooping cough.

2. The test material is mucus from the upper respiratory tract, which is deposited on the back of the pharynx when coughing, which is taken on an empty stomach or 2-3 hours after eating, before rinsing or other types of treatment.

3. Taking the material is carried out by medical personnel of medical and preventive and children's organizations who have passed the appropriate briefing. The material is taken in a specially designated for these purposes premises of medical and preventive and children's organizations. In some cases, the material can be taken at home. The material is taken using a spatula in good light from the posterior pharyngeal wall, without touching the tongue and inner surfaces of the cheeks and teeth with a swab.

4. For bacteriological diagnosis, the material is taken: with a posterior pharyngeal swab, "cough plates".

The material is taken with a posterior pharyngeal swab both for diagnostic purposes and for epidemic indications. The "cough plates" method is used only for diagnostic purposes in the presence of a cough. In infants, the pathological material is taken with a posterior pharyngeal swab.

To take the material, either laboratory-made swabs or sterile aluminum-based cotton or viscose swabs in an individual plastic tube are used. When removing from the test tube, the end of the swab is bent at an obtuse angle (110-120°).

The pathological material is taken with two swabs: dry and moistened with buffered saline. Taking the material with a dry swab stimulates coughing and increases the possibility of isolating the pathogen when taking the material with a second wet swab. The material from a dry swab is sown on a Petri dish with a nutrient medium at the place of taking, and from a wet swab, inoculation is carried out after the swab is delivered to the laboratory.

The material is taken with "cough plates" for 2 cups with a nutrient medium, during a coughing fit, a cup with a nutrient medium is brought at a distance of 10-12 cm so that droplets of mucus from the respiratory tract fall on the surface of the medium. The cup is held in this position for some time (for 6-8 coughing shocks), with a short cough, the cup is brought up again. Saliva, vomit, sputum should not get on the nutrient medium. Then the cup with the nutrient medium is closed with a lid and delivered to the laboratory.

Swabs and cultures with pathological material are delivered to the laboratory in thermos bags, be sure to protect it from direct sunlight and keep it at a temperature of 35-37 ° C, no later than 2-4 hours after taking the material.

5. For molecular genetic studies, pathological material from the posterior wall of the oropharynx is collected sequentially by two dry sterile polystyrene probes with viscose swabs, which are combined into one sample.

After taking the working part of the probe with a swab is placed to a depth of 1.5 cm in a sterile disposable test tube with 0.5 ml of transport medium or sterile saline (both swabs are placed in one test tube). The handle of the probe with the swab is lowered down and broken off, holding the tube cap. The vial is sealed and labelled.

It is allowed to store the material for three days at a temperature of 2-8°C. A test tube with pathological material is placed in an individual plastic bag and delivered to the laboratory in thermos bags at a temperature of 4-8°C, accompanied by documentation.

6. For a serological study (ELISA), blood must be taken on an empty stomach from a vein in a volume of 3-4 ml or from the pad of the third phalanx of the middle finger in a volume of 0.5-1.0 ml (in young children) into a disposable plastic tube without anticoagulant .

Blood is taken from the cubital vein to obtain serum with a disposable needle (diameter 0.8-1.1 mm) into a test tube without anticoagulant or a disposable syringe with a volume of 5 ml. When taking into a syringe, the blood from it is carefully (without foaming) transferred to a disposable glass tube. Capillary blood is taken from a finger under aseptic conditions in test tubes without anticoagulant, left at room temperature for 30 minutes or placed in a thermostat at 37°C for 15 minutes. Then centrifugation is carried out for 10 min at 3000 rpm, after which the serum is transferred into sterile tubes.

Each tube is labeled, placed in a plastic bag and delivered to the laboratory, accompanied by documentation, in thermos bags at a temperature of 4-8°C, excluding its freezing in winter.

Blood serum is stored at room temperature for 6 hours, at a temperature of 4-8°C for 5 days, at a temperature not higher than -20°C - up to 3 months. Repeated freezing / thawing of blood serum is unacceptable.

7. The test material must be numbered and have accompanying documentation, which indicates: last name, first name, patronymic; age; the address of the examined person; the name of the institution sending the material; date of illness; method of laboratory diagnostics; the name of the material and the method of its taking; date and time of taking the material; the purpose of the survey; frequency of examination; signature of the person who took the material.

8. Medical workers who take pathological material are instructed at least once a year. Doctors of clinical laboratory diagnostics improve their qualifications at thematic improvement courses on laboratory diagnosis of whooping cough.

Appendix 2. Interpretation of the results of serological diagnosis of whooping cough using the method of enzyme immunoassay (ELISA)

Appendix 2
to SP 3.1.2.3162-14

Serological diagnosis of whooping cough is carried out by ELISA using reagent kits to determine the level of specific anti-pertussis antibodies of the IgM, IgA, IgG classes, registered and approved for use on the territory of the Russian Federation in accordance with the procedure established by law. In the instructions for use of the test systems, a threshold level of antibodies is defined, above which the result is considered positive.

The study is carried out starting from the 3rd week of the disease.

The tactics of serological research should be built taking into account the patterns of formation of the immune response in unvaccinated and vaccinated individuals.

At the beginning of the acute stage of whooping cough in unvaccinated children and adults, IgM antibodies are formed, which can be detected starting from the 2nd week of the disease. A negative result for this class of antibodies in the first two weeks does not rule out infection with pertussis, as a negative test result may be due to low levels of antibodies. The acute process and progression of the disease is accompanied by the appearance of IgA and IgG antibodies at 2-3 weeks from the onset of the disease.

Confirmation of the clinical diagnosis of whooping cough in unvaccinated patients is the detection of IgM antibodies or IgM antibodies with various combinations of IgA and IgG antibodies in a single study of blood sera. If negative results are obtained, the study is repeated after 10-14 days.

In children vaccinated against whooping cough and who have lost post-vaccination antibodies over time, the immune response is formed according to the secondary type: on the 2nd-3rd week of the disease, an intensive increase in IgG antibodies occurs, the level of which exceeds the threshold by 4 or more times, or against the background of low production IgM antibodies there is a rapid increase in IgA antibodies, and then IgG antibodies in indicators exceeding the threshold level by 4 or more times.

To assess the increase in the level of specific antibodies in vaccinated children, it is necessary to study paired sera with an interval of 10-14 days. When planning a study of paired sera from vaccinated individuals, it is permissible to take the first sample, regardless of the timing of the disease. If during the initial study of blood serum from a child vaccinated against whooping cough, IgG antibodies are detected in an amount exceeding the threshold level by 4 or more times, a second study is not carried out.

The study of paired sera samples taken from both unvaccinated and vaccinated individuals is recommended to be carried out on the same panel.

In case of illness in children during the first months of life, taking into account the peculiarities of immunogenesis at this age (delayed seroconversion), it is advisable to conduct a study of paired blood sera of both the child and the mother.

Annex 3. Brief description of the clinical forms of whooping cough in children

Appendix 3
to SP 3.1.2.3162-14

Allocate typical and atypical forms of whooping cough.

During whooping cough, 4 periods are distinguished: incubation, prodromal, spasmodic and the period of reverse development.

The incubation period for all forms of whooping cough ranges from 7 to 21 days.

Typical forms of whooping cough are divided into mild, moderate, severe, atypical, whooping cough in children during the first months of life and bacteriocarrier.

1. Typical shapes:

- Mild forms of typical whooping cough include diseases in which the number of coughing attacks does not exceed 15 per day, and the general condition is disturbed to a slight extent.

The prodromal period lasts an average of 10-14 days. The main symptom of incipient whooping cough is a cough, usually dry, obsessive in half of the cases, observed more often at night or before bedtime. The well-being of the child and his behavior, as a rule, do not change. The cough gradually intensifies, becomes more persistent, obsessive, and then paroxysmal in nature, and the disease passes into a spasmodic period.

A paroxysmal cough is characterized by a series of rapidly following expiratory thrusts, followed by a convulsive whistling breath - a reprise. In isolated children, vomiting occurs with separate attacks of coughing. A more constant symptom is a slight swelling of the face and especially the eyelids, which is found in almost half of the patients.

Auscultation reveals harsh breathing in a number of children. Wheezing is usually not audible.

In blood tests, only a part of patients with a mild form show a tendency to an increase in the total number of leukocytes and lymphocytosis, however, the changes are insignificant and cannot be used for diagnostic purposes.

Despite the mild course, the spasmodic period remains long and averages 4.5 weeks.

In the period of resolution, lasting 1-2 weeks, the cough loses its typical character and becomes less frequent and easier.

- The moderate form is characterized by an increase in the number of coughing attacks from 16 to 25 times a day or more rare but severe attacks, frequent reprisals and a noticeable deterioration in the general condition.

The prodromal period is shorter, averaging 7-9 days, the spasmodic period is 5 weeks or more.

There are changes in the behavior and well-being of the patient, there is an increase in mental excitability, irritability, weakness, lethargy, sleep disturbance. Cough attacks are prolonged, accompanied by cyanosis of the face and cause fatigue of the child. The phenomena of hypoxia can persist outside of coughing fits.

Puffiness of the face is almost constantly observed, signs of hemorrhagic syndrome appear.

In the lungs, dry and mixed moist rales are often heard, which can disappear after coughing fits and reappear after a short time.

With great constancy, changes in white blood are detected: leukocytosis up to 20-30 per 10/l, absolute and relative increase in lymphocytes with normal or reduced ESR.

- For severe forms, a more significant severity and variety of clinical manifestations are characteristic. The frequency of coughing attacks reaches 30 per day or more.

The prodromal period is usually shortened to 3-5 days. With the onset of the spasmodic period, the general condition of children is significantly disturbed. There is a decrease in body weight. Children are lethargic, sleep inversion is possible.

Cough attacks are long, accompanied by cyanosis of the face. Against the background of increasing hypoxia, respiratory and later cardiovascular insufficiency develops. In children of the first months of life, respiratory arrest may occur - apnea associated with overexcitation of the respiratory center and the spastic state of the respiratory muscles. In premature babies, as well as in cases of damage to the central nervous system, apnea occurs more often and can be prolonged. In some cases, there are encephalic disorders ("pertussis encephalopathy"), accompanied by convulsions of a clonic and clonic-tonic character, depression of consciousness.

Along with prolonged respiratory arrest, severe encephalic disorders are the most dangerous manifestations of pertussis infection and, against the background of a sharply reduced mortality, remain one of the main causes of deaths in whooping cough.

The auscultatory picture corresponds to the clinical manifestations of "pertussis lung".

In the spasmodic period, symptoms of disorders of the cardiovascular system are more often observed: tachycardia, increased blood pressure, puffiness of the face, sometimes swelling on the hands and feet, petechiae on the face and upper body, hemorrhages in the sclera, nosebleeds.

In most cases, there are changes in the blood: pronounced leukocytosis up to 40-80 thousand in 1 mm of blood. The specific gravity of lymphocytes is up to 70-80%.

2. The atypical form is characterized by an atypical cough, the absence of a consistent change in the periods of the disease.

The duration of the cough ranges from 7 to 50 days, with an average of 30 days. The cough, as a rule, is dry, obsessive, with facial tension, occurs mainly at night and intensifies at the time corresponding to the transition of the catarrhal period to the spasmodic one (on the 2nd week from the onset of the disease). Sometimes it is possible to observe the appearance of single typical coughing fits when the child is agitated, while eating, or in connection with the layering of intercurrent diseases.

Of the other features of the atypical form, it should be noted a rare increase in temperature and a weak severity of catarrhs of the mucous membranes of the nose and throat.

Physical examination of the lungs reveals emphysema.

3. Whooping cough in children during the first months of life is characterized by significant severity. The prodromal period is shortened to several days and hardly noticeable, while the spasmodic period is lengthened to 1.5-2.0 months. A feature of spasmodic cough is the absence of characteristic reprises. Coughing fits consist of short expiratory thrusts. First, hyperemia of the superciliary arches and orbits of the eyes appears, then hyperemia of the face, which is replaced by diffuse cyanosis of the face and oral mucosa. Coughing attacks are accompanied by breath holding up to the occurrence of apnea. Apnea in children under three months is observed in almost half of the cases, and in children of the second half of the year it is rarely observed. Young children are 6-8 times more likely to develop neurological disorders.

4. Bacteriocarrier of the whooping cough pathogen is observed in adults and older children vaccinated against whooping cough or who have recovered from this infection. The duration of the bacteriocarrier, as a rule, does not exceed two weeks.

Electronic text of the document
prepared by CJSC "Kodeks" and verified according to.