Whooping cough outbreak Hawea/Wanaka

Monday, 10 August 2015

Hawea/Wanaka area is experiencing an outbreak of whooping cough/pertussis with 14 confirmed and two probable cases identified between 27 July and 6 August.

The local public health unit is responding to this outbreak and has provided information on immunisation and public health measures to local schools, midwives, general practitioners and practice nurses in the region.

Providing a timely, free whooping cough booster immunisation to pregnant women between 28-38 weeks of pregnancy and providing on-time immunisation to infants at 6 weeks 3 months, and 5 months of age are the best ways to protect our most vulnerable children from the disease.

For more information read our fact sheets:

 Recommended and funded vaccines during pregnancy, and

 Pertussis (Whooping cough).



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Changing pertussis strains

Thursday, 22 March 2012

Researchers at the University of New South Wales have identified an increase in pertussis cases caused by strains that are different to those in the acellular pertussis vaccine.

Australia has been experiencing epidemic levels of pertussis (whooping cough) since 2008 despite high levels of immunisation. However, deaths from the disease are lower than before immunisation against the disease was introduced.

Research into the strains of pertussis bacteria causing the disease in Australia between 2008-2010 has been published online in the Journal of Infectious Diseases. The study found an increase in the number of non-vaccine pertussis bacteria isolated in samples from people with the disease between between 2008-2010 compared with the number isolated between 2000-2007.

The next step is to identify if the non-vaccine strains are more likely or less likely to be causing more serious pertussis disease than the vaccine strains. A project between the National Centre for Immunisation Research and Surveillance (NCIRS) in Australia and the university researchers is underway.

Continued immunisation with the current whooping cough vaccines, following the National Immunisation Schedule, is recommended until the implications of the non-vaccine pertussis strain can be identified.

Professor McIntyre, Director of NCIRS commented that The vaccine may not be as good as we'd like but it does seem to be preventing the most extreme cases." Australia is reviewing whether a a booster pertussis immunisation should be added to the Australian schedule at 18 months of age.

The citation for the recently published journal article is Octavia, S., Sintchenko, V., Gilbert, G. L., Lawrence, A., Keil, A. D., Hogg, G., & Lan, R. (2012). Newly Emerging Clones of Bordetella pertussis Carrying prn2 and ptxP3 Alleles Implicated in Australian Pertussis Epidemic in 2008–2010. Journal of Infectious Diseases, 205(8), 1220-1224.



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Immunisation against whooping cough

Friday, 3 August 2012

Researchers at the Queensland Children's Medical Research Institute recently published data comparing the rate of pertussis in children who received the whole-cell pertussis vaccine with children who received the acellular vaccine.

Not surprisingly they identified that children who received the whole-cell vaccine were less likely to get whooping cough.

A number of factors could contribute to the results of this study:

  • Technology that tests for pertussis infection has improved significantly since the whole-cell vaccine was used in Australia, and New Zealand, and an increase in the number of laboratory diagnosed cases may reflect better identification of the disease now than back then.
  • The whole-cell vaccine, used overseas as part of the World Health Organization Expanded Programme on Immunization, generates a very robust immune response that can be associated with noticeable injection site reactions, high fevers and hours of persistent screaming. New Zealand, Australia, the UK and US moved to using the acellular pertussis vaccine to reduce the risk of these unpleasant and, for parents, often frightening and unacceptable vaccine responses. However, a less reactive vaccine also means a reduction in the immune response when compared with the whole-cell vaccine.
  • It is possible that over time there have been small changes in characteristics of the pertussis bacteria and the current acellular pertussis vaccine is still effective against much of the bacteria's characteristics but is less effective against the changed ones.
  • Pertussis remains highly infectious and no matter how immunity is acquired i.e. through whole-cell immunisation, acellular pertussis immunisation or actually having the wild type disease, immunity wanes over time and controlling the disease remains a significant challenge.

The key messages are:

  • The acellular pertussis vaccine still has a protective effect and it is important for infants to receive their National Immunisation Schedule vaccines on time at 6 weeks, 3 months and 5 months of age.
  • Parents and people in close contact with infants less than one year of age should have their immunity against pertussis boosted by immunisation to reduce the risk they will infect a vulnerable infant.
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Baby Sativah's struggle with whooping cough

Monday, 27 August 2012

Three week old Sativah's video highlights effects of whooping cough on babies.

Waikato mum Stacey Illingworth is sharing video footage of her baby’s struggle with whooping cough to help prevent other parents going through the same trauma. Stacey and her daughter Sativah returned home to Te Aroha recently after spending five weeks in Waikato Hospital.

“I would hate for any family to have gone through what we have. It is the worst possible feeling waking up at 5am to find your little baby lying there not breathing, and nearly losing her. I urge everyone to vaccinate their babies as soon as they can and for mums and dads to get immunised too,” Ms Illingworth said.

View the full Ministry of Health media release here.

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Infanrix®-IPV is used for primary and booster vaccination of infants and children to protect against diphtheria, tetanus, pertussis and poliomyelitis. Infanrix®-IPV can also be used for catch-up immunisation for children up to their 10th birthday.



Infanrix®-hexa is used for primary and booster vaccination of infants and children to protect against diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis and disease caused by Haemophilus influenzae type b. Infanrix®-hexa can also be used for catch-up immunisation for children up to their 10th birthday.




Adacel® is a privately purchased vaccine that protects against tetanus, diphtheria and whooping cough.

Should pre-term Infants be immunised?


Yes. Pre-term infants should be immunised by their actual (chronological) age i.e. the number of weeks or months since their birth. Pre-term infants have a higher risk of diseases including whooping cough, Haemophilus influenzae type b, pneumococcal disease and influenza. They may also experience serious complications and/or develop long-term problems if they contract these diseases.

Being born starts the maturing of the infant's immune system. Pre-term infants can develop an immune response to immunisations. There is some evidence that low birth weight infants (less than 2000g) may not build sufficient antibodies against hepatitis B immunisation at birth. However, infants born to mothers with hepatitis B should still be given a birth hepatitis B vaccine, as well as hepatitis B immunoglobulin. By six weeks of age almost all low birth weight infants will have an immune response to hepatitis B equivalent to heavier infants.

No scientific evidence supports the myth that immunisation can “overwhelm” an infant's immune system.

Pre-term infants do not have any more side effects from immunisation than infants born at full-term. There is no evidence of a risk of apnoea (pauses in breathing) after immunisation of babies born less than 1000g or 31 weeks gestation with the acellular pertussis (whooping cough) vaccine. However, it is recommended that these infants are monitored for apnoeic episodes for 72 hours after immunisation until further data can confirm this pattern of safety. 

FAQ types: 


Common Name: 
Whooping cough
Parents & Caregivers

Pertussis, commonly known as whooping cough, is a highly infectious bacterial infection spread by coughing and sneezing. It causes severe bouts of coughing, which may be accompanied by vomiting and a whooping sound. Pertussis can last up to 3 months and is sometimes referred to as the ‘100 day cough.’ The symptoms are more obvious in children, because infants and adults are less likely to ‘whoop.’

The current New Zealand situation: 

New Zealand has epidemics every 3-5 years with several thousand cases (mostly young children) reported in each epidemic. Older adolescents and adult pertussis often goes unrecognised and is often under reported. Up to a third of adolescents and young adults with a persistent cough have evidence of recent pertussis infection.


Pertussis can be divided into three stages:

The initial stage, following the incubation stage, is called the catarrhal stage is the most infectious. It lasts 7-10 days and can include a runny nose, sneezing, slight fever, and a mild irritating cough.

The second stage or paroxysmal stage usually lasts 2-4 weeks, but can persist for up to 10 weeks. A paroxysm is a spasm of coughing followed by a big breath in or high pitched whoop in children. Infants and adults generally do not have the characteristic 'whoop' sound. Infants and young children often appear very ill, and may turn blue and vomit with coughing bouts.

The convalescent stage may last for months. Although the cough eventually disappears after several weeks, coughing fits may recur whenever the patient suffers any subsequent respiratory infection.


How do you get it?: 

Pertussis is highly contagious and is spread by coughing and sneezing. It infects around 90% of non-immune household contacts and 50 to 80% of non-immune school contacts. Many babies catch it from their older siblings or parents - often before they are old enough to be fully vaccinated.

What are the risks?: 

Around five in 10 babies who catch pertussis before the age of 12 months require hospitalisation and 1-2 in 100 of those hospitalised die from pertussis infection. Severe coughing can temporarily stop the oxygen supply to the brain (hypoxia). In around two in 1000 children pertussis leads to permanent brain damage, paralysis, deafness or blindness. Secondary infections such as pneumonia and ear infections can occur.

The disease is usually milder in adolescents and adults, consisting of a persistent cough similar to that found in other upper respiratory infections, although some adults will collapse or experience a rib fracture from violent coughing. Both hospitalisations and deaths are likely to be under-estimated in adults due to the lack of the ‘whooping’ sound.

Who is most at risk?: 

Those most at risk of serious disease are infants under 12 months of age. Infants who do not receive doses of pertussis containing vaccine at the scheduled times of 6 weeks, 3 months, and 5 months have up to a five-fold increased risk of being hospitalised with pertussis.

Preventing Disease Spread: 

A free whooping cough booster immunisation is recommended for pregnant women between 28-38 weeks gestation. The booster immunisation increases the amount of protection against whooping cough that can pass through the placenta into the baby, providing them with some of their own protection against severe whooping cough for a period of time after their birth (around 4-6 weeks). The tetanus, diphtheria and pertussis (whooping cough) booster immunisation can also reduce the risk the mother will have the disease when the baby is born and for the subsequent year when the baby's risk of complications from whooping cough is highest.

On-time immunisations for infants at 6 weeks, 3 months and 5 months in addition to children receiving boosters at four years and 11 years is the best prevention.

Breastfeeding does not provide direct protection against whooping cough.

Antibiotics do not cure pertussis but are given to reduce the spread of infection to others.

All cases of pertussis should be excluded from early childhood services, school, or community gatherings until they are well enough to attend and have either received five days of antibiotics or three weeks have elapsed since the onset of coughing spasms.


Health Professionals
Causative organism: 

Pertussis is caused by a bacterium, Bordetella pertussis; a gram-negative bacillus, which colonises the upper respiratory tract. There are other organisms such as Bordetella parapertussis, Mycoplasma pneumoniae and Chlamydia pneumoniae, which can cause a pertussis-like illness.

Clinical signs, symptoms and complications: 

Pertussis disease can be divided into three stages:

Catarrhal stage

Can last 7-10 days and includes a runny nose, sneezing, low-grade fever, and a mild cough (all similar symptoms to the common cold).

 Paroxysmal stage

  • Usually lasts 1-6 weeks, but can persist for up to 10 weeks.
  • The characteristic symptom is a burst, or paroxysm, of numerous, rapid coughs.
  • At the end of the paroxysm the patient suffers from a long inhaling effort that is characterized by a high-pitched whoop.
  • Infants and young children often appear very ill and distressed, and may turn blue and vomit. Infants generally do not have the characteristic “whoop” sound.

Convalescent stage

  • May last for months.
  • Although the cough usually disappears after 2-3 weeks, paroxysms may recur whenever the patient suffers any subsequent respiratory infection.
  • Disease is more severe in infants and young children.
  • The cough may persist for up to 3 months and is often associated with vomiting.
  • Severe coughing may lead to brain hypoxia. In 1-3 per 1000 children, whooping cough leads to permanent brain damage, paralysis, deafness or blindness.

The disease is usually milder in adolescents and adults, consisting of a persistent cough similar to that found in other upper respiratory infections. However, these individuals are still able to transmit the disease to others, including unimmunised or incompletely immunised infants.

Pertussis immunity wanes over time; both following natural disease and vaccination (immunity lasts 4–10 years). Re-infection may present as a persistent cough, rather than typical pertussis.


Method of transmission: 

Pertussis is spread through the air by infectious droplets and is highly contagious infecting 90% of susceptible household contacts and 50 to 80% of susceptible school contacts. The incubation period is commonly 7-10 days, with an upper limit of 21 days. Many babies contract pertussis from their older siblings or parents.

Public health significance: 

Pertussis kills about 250,000 children worldwide each year. Many children are left with brain damage from pertussis infection. Pertussis is highly infectious and around 90% of non-immune household contacts will contract it.

Most countries have epidemics every three to five years.

Both hospitalisation and deaths from pertussis are likely to be underestimated as infants, particularly preterm, may either present without characteristic symptoms or be misclassified as sudden infant death syndrome.

It has been estimated that up to 20% of severe adult coughs 1-3 months untreated, could be caused by pertussis infection. These individuals are a significant reservoir of infection.

Some countries such as USA, Australia and Canada are now identifying higher rates of pertussis infection, especially in adolescents and adults. The cause of this is not yet fully explained however these countries are introducing pertussis boosters for adolescents.

Those most at risk are young babies. Around 50% of those who catch pertussis before the age of 12 months require hospitalisation. Children under 12 months who are ill enough to be admitted to hospital have a 1-2 in 100 chance of dying.

Currently available vaccines prevent disease much better than they prevent infection. They will not eradicate pertussis but in countries with very high immunisation coverage rates (>95%), the three to fiuve yearly epidemics affect fewer individuals and the resultant disease is less severe than in unvaccinated communities.


New Zealand epidemiology: 

The estimated pertussis case fatality rate in New Zealand for the period 1970 to 1992 was 0.4 percent. This is comparable to reported case fatality rates from the UK and the US over a similar period. There were no deaths from pertussis in New Zealand between 1988 and 1995, one death in 1996, and since 1999 there has been one death each year up to 2004. Morbidity from pertussis in New Zealand has been described primarily using hospital discharge data. National passive surveillance data has been available since 1996, when pertussis became a notifiable disease. Comparison of notification and hospitalisation data from 1996 and 1997 demonstrates that fewer than 50 percent of hospitalised cases are notified. The three to four year periodicity of pertussis epidemics in New Zealand is similar to that seen in many other countries. The decrease in the pertussis hospitalisation rate that occurred following the introduction of mass immunisation has not been sustained.


There is almost no maternal protection passed to the newborn against pertussis via breastmilk.

Cases should be excluded from school or daycare until the infectious period is over (21 days from the onset of coughing or after 5 days of antibiotics). Some countries recommend health care workers and/or daycare workers with confirmed pertussis infection be placed on sick leave until fully recovered.

Pertussis vaccines were initially developed in the 1940s.

There are two types of pertussis vaccine commonly used internationally: whole cell pertussis vaccine (wP) and acellular vaccine (aP). Both vaccines have similar efficacy but acellular vaccines cause significantly fewer adverse reactions than whole cell vaccines. Where feasible and available, acellular vaccines should be used in preference to whole cell vaccines.

Acellular pertussis-containing vaccines have now replaced whole-cell vaccines in many countries, including New Zealand. There are a number of acellular pertussis vaccines, which contain three or more purified components of B. pertussis: pertussis toxin (PT), filamentous haemagglutinin (FHA), pertactin (PRN), and fimbrial antigens or agglutinogens.


Antibiotics have no role in treating pertussis. However they are given to reduce transmission of the organism and may be given to all household and other close contacts of the patient.

Identification of pertussis infection and prescription of antibiotics for women in the third trimester of pregnancy minimises the spread to non-immune infants in the first month of life.

Disease Effects vs Vaccine Side Effects (Table)
Disease Description: 

Pertussis is a highly infectious bacterial disease of the respiratory system. Symptoms inlcude a severe cough which can last for many weeks. Pertussis is very serious in young infants.

Effects of disease: 
Secondary infections such as pneumonia and ear infections can occur.
Around 5 in 10 infants who catch pertussis before the age of six months require hospitalisation.
Severe coughing can temporarily stop the oxygen supply to the brain (hypoxia).
Around 1-2 in 100 hospitalised infants younger than 12 months die.
Around 2 in 1000 children with paroxysmal cough develop permanent brain damage, paralysis, deafness or blindness.
Urinary incontinence in adults
Some adults will collapse or experience a rib fracture from violent coughing.
Common side effects of vaccine: 
Soreness/pain, redness and/or swelling around the injection site.
Fever over 38°C.
Decreased appetite, vomiting and/or diarrhoea.
Irritability, restlessness.
Unusual crying.
Redness and/or swelling more than 6 cm in size around the injection site. In a small percentage of vaccine recipients the reactions will be severe enough to limit movement of the arm and may last for about a week.
Swelling involving the entire thigh or upper arm occurs in 2–3 percent of children after administration of the fourth and fifth doses of acellular pertussis vaccine. It resolves spontaneously without long term consequences.
Uncommon side effects of vaccine: 
Fever over 39°C.
Muscle or joint stiffness or pain.
Rare/very rare side effects of vaccine: 
High fever over 40°C.
Persistent (> 3 hours) inconsolable screaming.
Hypotonic, hyporesponsive episode (HHE) with 24 hours of immunisation.
Inflammation of the nerve in the arm causing muscle weakness and pain (brachial neuritis) occurs within four weeks of immunisation, 1- 2 times per 200,000 doses.
Convulsion within 2 days of immunisation.
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