Whooping cough cases surge in Europe

What is behind the troubling uptick?
22 March 2024

Interview with 

Adam Finn, Bristol Medical School


Clip art of a woman coughing


Europe is facing its worst outbreak of whooping cough in a decade. Cases of the contagious infection - which is also known as pertussis - have been particularly acute in the Czech Republic, which has recorded its highest number of cases since the 1960s. The UK is also seeing an uptick in cases. But why? Adam Finn is professor of paediatrics at Bristol Medical School…

Adam - So this bugged a bacterium that lives in people's noses and mouths and throats, and it passes itself around between people by making them cough. It's quite common in the population. People who get a persistent cough that goes on for two or three months often are infected with this bug. But the reason we really, really care about it is that very young children, particularly in the first few weeks of life, get desperately ill. And indeed many of them die. So it's a very serious infection in very young children.

Chris - Do we know why it's so nasty?

Adam - It's so nasty because it makes a combination of toxic proteins that are very effective at making you cough. And it does that in order to pass itself around. But that is disastrous when it affects the respiratory tract, the lungs, and the nose and throat of a very small baby because it makes it almost impossible for them to breathe and they end up without enough oxygen. They end up with pneumonia, with infection in their lungs, which can permanently damage the lungs and they end up with brain damage and even other organs of the body can be damaged as well. So that's why it's such a nasty bug. It has this combination of factors that make these babies so desperately ill.

Chris - We do have a vaccine program, thankfully though, don't we? Is that effective?

Adam - We do indeed. And this vaccine program began a long time ago in the 1950s, at which time we used to have big epidemics of whooping cough about every three years with many hundreds of children dying and thousands of children affected. The problem seemed to have gone away. Unfortunately, what's turned out is that the vaccines that we currently use don't provide lifelong protection. So they protect the babies once they're vaccinated, but that protection doesn't last forever. And so they can get the infection later on in life when they're adolescents, when they're young adults. And that in turn means that they can infect their children and young babies who've not yet been vaccinated and still get sick.

Chris - So you succumb again to infection, but are you as desperately ill as you would've been were you not vaccinated?

Adam - We can't actually start vaccinating children till they're two months old. They need three doses of vaccines at two, three and four months. So they're not really fully protected until they're five or six months old and that means you've still got this vulnerable period very early on in life. And if the bacterium is still circulating amongst adults, then these babies are still going to get infected. So the way to solve that problem is to protect them from the time of birth. And the way we do that is by immunising the mothers with a vaccine when they're pregnant.

Chris - And how effective is this? So are adults succumbing to pertussis or whooping cough infection without realising it. So we've got the thing going through the population, but because they've been vaccinated earlier in life, they're getting a less severe infection and might not realise it.

Adam - That's right. I mean, you cough even in an unvaccinated adult is a nuisance. It makes you cough for a long time. You wouldn't like it. And you'll be feeling rotten with it for a while, but it won't kill you and you'll recover. So that's right. People perhaps don't realise they've got the whooping cough, they've got a persistent cough and they don't recognize what it is. But if they're in contact with small children, then that's when the disaster occurs. We don't at the moment have vaccines that are capable of eliminating the circulation of the bacterium altogether. We just don't have them. So the only way we can solve the problem in young children is by immunising them, and even more than that, by immunising their mothers before they're born.

Chris - We're seeing a big uptick in cases though in some countries. We've seen it go from a few tens of cases in a month to literally thousands of cases in a month. We are seeing an uptick here as well. Why do you think the numbers are suddenly climbing?

Adam - The main reason right now is that like many other infectious diseases during the covid pandemic, when everybody was not in contact with each other, whooping cough went away. So there was nobody getting whooping cough. It is a very good way of preventing infections, is just keeping people apart from each other. But of course, once we go back to normal life as we are now, then those infections come surging back and that's what's happening with whooping cough at the moment. But the other reason for it is that whooping cough has always been an illness that comes in waves. So we have a period when there are lots of cases and then more people get immune because they've had the infection or been vaccinated and it goes back down again. So we're seeing one of those waves now, but it is going to be bigger and stronger because of this absence of circulation and lack of immunity that built up during the period of the covid pandemic.

Chris - And vaccine uptake rates, have they been dented as well? Because we've seen that with, for instance, measles, which is also rearing its ugly head in our country.

Adam - Yes, unfortunately, vaccine coverage rates in this country are gradually sinking down. And I think that's due to the underinvestment in the NHS. So there's been less resources to make these programs work well, and to some degree, you know, people are losing their faith in vaccines and, and perhaps having doubts about the benefits and the importance of getting themselves and their children vaccinated. So we are seeing falling rates of vaccination and of course that makes the situation much more dangerous.

Chris - So if a person runs into the infection, they take a trip to one of these European countries where they're seeing a big surge or they know they've had contact with it. What should a person do and how do we treat it?

Adam - The only way to avoid whooping cough is to avoid being exposed to people with a cough or be vaccinated. We don't currently vaccinate adults routinely unless they're pregnant women. So the really important thing that we need to do at the moment is to make sure that pregnant women are aware of this program. Aware of the importance of it for them and their baby, and to inform all parents that they need to get their children immunised against whooping cough with the routine schedule. And if they've missed any doses, they need to get in touch with their GP and get the baby or the child immunised up to date straight away.


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