Whooping cough and tuberculosis are doing well. The doctor warns: these are not forgotten diseases

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Over 50 thousand children are not vaccinated against whooping cough and tuberculosis is still a problem. While they seem like a forgotten disease, they are actually still a threat. Unfortunately, the declining desire to vaccinate means that many diseases can come back. Dr. hab. n. med. Tadeusz Zielonka, pulmonologist from the Chair and Department of Family Medicine at the Medical University of Warsaw.

1. Whooping cough can be very serious, especially for infants who are not yet vaccinated, but also for adults who have chronic diseases
2. Few people know that whooping cough immunization should be repeated every 10 years
3. Dr. Zielonka reminds that tuberculosis is still a problem, as some of its strains elude drugs
4. The expert urges not to underestimate the role of vaccination. “It is important that we vaccinate ourselves, and not just try to save lives in danger”
5. You can find more such stories on the TvoiLokony home page

Journalists for Health Association: Tuberculosis and whooping cough remain dangerous to the lungs in the era of the coronavirus pandemic. How do we deal with these diseases?

Dr hab. Tadeusz Zielonka, MD, PhD: Let’s start with whooping cough. Vaccination against this disease is mandatory. In the basic four-dose schedule, the vaccine is given at 2, 4 and 6 months of age, and then at 16-18. month of life. Booster doses are given at 6 and 14 years of age. At 19 years of age, pertussis vaccination is recommended. We had a very good, over 90% implementation of compulsory vaccinations against whooping cough in Poland. Unfortunately, anti-vaccine movements meant that in 2007 there were over 4 unvaccinated. children, and in 2020 already over 50 thousand.

Who should get vaccinated against whooping cough in the first place?

Dr hab. Tadeusz Zielonka, MD, PhD

Adults are recommended to take a booster dose every 10 years. This should be done in particular by people at risk: medical staff who come into contact with newborns and infants, the elderly, especially those with chronic diseases leading to heart, lung, kidney or liver failure, and pregnant women after 27 weeks of pregnancy ( it is about the safety of the child). People from the environment of the newborn (parents, grandparents, etc.) who will have contact with it for the first 12 months of life should also be vaccinated, because unvaccinated children most often get infected from them. Unfortunately, despite the recommendations, a very small percentage of adults in Poland are vaccinated against whooping cough.

Do young people want to get vaccinated?

Recently, discussions have taken place in connection with the COVID-19 vaccination. Young people asked: why should I vaccinate when the risk of dying is so small? I replied: you have to get vaccinated so that your grandparents, whom you can infect, do not die. The same is true with whooping cough. You are vaccinated to protect your unvaccinated young child, who could be fatal for this disease. We vaccinate ourselves and others, it is a kind of collective responsibility that cannot be dominated by selfishness.

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Can you confuse whooping cough with COVID-19?

You can, because they are indistinguishable at first. The main symptom of whooping cough in adults is cough, as in COVID-19, and two-thirds of patients have common cold symptoms, as in the initial stage of SARS-CoV-2 infection. As no microbiological or genetic tests are performed in the catarrhal phase of whooping cough, the vast majority of cases are undiagnosed. PZH studies have shown that only one in more than 70 cases of whooping cough is registered, and in the 60 plus population – one in 300 patients.

The disease is therefore very underdiagnosed. We do not know the scale of whooping cough because we do not do tests to determine the cause of respiratory tract infection.

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How is whooping cough in adults?

Certainly more gentle than in young unvaccinated children. The patient does not feel well, has a low-grade fever and symptoms of upper respiratory tract catarrh. Then he starts to have a heavy, paroxysmal cough. It can be so strong that it leads to vomiting, apnea, fainting and even fracture of the ribs. With such a cough, you must always think about whooping cough and do immunological tests that will confirm it (it is often too late for molecular or breeding tests then). The Japanese call whooping cough a 100-day cough because it lasts for several months.

For whom is whooping cough especially dangerous?

For unvaccinated children in the first two months of life. They are then exposed to serious, even fatal, disease. Although whooping cough does not cause death as often in adults as in unvaccinated children, it can be dangerous especially in comorbidities such as obesity, diabetes, asthma, COPD, emphysema or hypertension (risk of vascular rupture). Dangerous are also post-cough complications, such as pneumonia, sinusitis, superinfections, etc. Urinary incontinence, chest pain, insomnia and fatigue caused by persistent cough are very troublesome. Therefore, we should get vaccinated. In the context of refugees, it is worth remembering that only about a third of children in Ukraine were vaccinated and these people are at risk of developing severe illness. It may also cause the spread of infection in the Polish population.

What about tuberculosis in Poland?

Unfortunately, he is still doing well, because some strains of this disease are constantly eluding us. The problem is its multi-drug resistance. It is worth mentioning the epidemic threats related to the current situation beyond our eastern borders. There are huge differences between Poland and Ukraine or Belarus in terms of not only tuberculosis incidence, but most of all multi-drug resistance. Therefore, there may be an increase in the cases of multi-drug resistant tuberculosis in our country. In Poland, men are much more ill than women (2: 1). Elderly or immunocompromised people are particularly at risk of tuberculosis. Disease reactivation in already treated patients account for 12%. all cases. Tuberculosis may become active, for example, as a result of chemo- or radiotherapy.

1. Read: Tuberculosis is a forgotten disease? Poland in the infamous leaders of Europe

Does vaccination protect against tuberculosis?

Unfortunately, it does not protect against tuberculosis, but protects against the acute and life-threatening course of the disease. It is worth getting vaccinated, because the vaccine reduces the risk of contracting milia and meningitis or galloping consumption, which once decimated the sick. The BCG vaccine (Bacillus Calmette-Guérin) is over 100 years old. I think the advancements that have been made with covid vaccination (it was a vaccinology leap!) Will translate into improved vaccination in areas where vaccination has not been ideal. The BCG vaccine is one of these.

What does tuberculosis prevention look like in Poland?

We give the vaccine only once, in the first 90 hours of life. Over 14 percent children in Poland are vaccinated. However, we have more and more children who come from abroad and are not vaccinated, because many European countries have withdrawn from the BCG vaccine. In Poland, there is a rule that these children should be vaccinated before the age of XNUMX. Unfortunately, some important conditions for BCG vaccination have not been defined, namely the exclusion that a child who has not been vaccinated has not been infected and does not have a so-called latent tuberculosis. Most countries recommend that you have a tuberculin test prior to vaccination, as BCG vaccination may worsen the situation in those who are infected. In Poland, we gave up tuberculin tests – they are practically unattainable with us, which makes it difficult to detect latent tuberculosis in this population.

How are other countries dealing with it?

In the United States, people with the so-called latent tuberculosis, i.e. those who have been in contact with Mycobacterium tuberculosis, should receive chemoprophylaxis, i.e. treatment with one anti-tuberculosis drug for six months, or shorter – with two drugs. The French use the shortest system – three-drug treatment. We are still facing this challenge, but chemoprophylaxis is used in selected groups of patients. I have patients who come in for qualification prior to biological treatment. They must be checked for the so-called latent tuberculosis. If they have, they should undergo chemoprophylaxis before biological treatment. This is the standard.

So what is worth calling for?

It is important that we vaccinate ourselves, and not just try to save lives in danger. The pandemic changed our lives, and perhaps also our consciousness. Covid taught us that an infection can kill you. And it should also teach us that prevention is very important. Let’s start thinking about how to protect ourselves from the onset of disease before spending millions on saving lives.

Authorized press interview prepared by the Journalists for Health Association in connection with the XXX edition of the Quo Vadis Medicina workshop, entitled Vaccination practice in Poland and new challenges, organized on the occasion of the European Vaccination Week, April 2022.

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