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An infectious diseases soup: whooping cough, swine flu and “Delhi belly”

Below is a soup of infectious diseases – a bit of whooping cough mixed in with swine flu and finished off with a dose of “Delhi belly”…

Are parents getting good advice on whooping cough?

NSW Health recently issued a warning for parents to be on alert for whooping cough (pertussis) following an increase in the number of school-aged children diagnosed with the disease over the last few weeks.

But should parents keep their young babies at home? This was the advice given in a recent article in the Sunday Telegraph.

That particular advice does not seem particularly well founded in evidence, says Kerrie Wiley, a PhD student with the University of Sydney who is studying influenza and pertussis vaccination in expectant and new mothers.

Kerrie Wiley writes:

A recent spate of media reports, including an article “Newborns at risk from fatal cough” which appeared in the Sunday Telegraph (Sydney) recently, advised parents “not to take newborns out to shopping centres, supermarkets and other air-conditioned places for the first six weeks because of a whooping cough epidemic”.

The reports then went on to say that if venturing out, parents shouldn’t take the pram – “A pram seems to be open slather for people to touch their baby”, and that parents should use a baby pouch or sling as an alternative.

Currently, the published scientific evidence on who gives whooping cough (pertussis) to young babies points to parents, siblings, and other close household contacts as being the likely source of the infection.

Recent studies report that when the source of a baby’s infection could be identified, it was traced back to a close household contact in around 15 – 45% of cases.

There are currently no published studies that suggest shopping centres or air conditioning are a significant source of whooping cough infection in infants.

Furthermore, what social and emotional effect is this advice going to have on new mothers?  For many, outings to public places such as shopping centres provide a social lifeline during a period which can be very isolating.

Do we really want to be encouraging new mothers – people who need the community’s support – to be isolating themselves, when there is really no convincing evidence that this is going to avert pertussis infection in their baby?

What kind of burden will this advice place on new mothers who now have to decide whether taking a trip to the shopping centre for a packet of nappies is worth the perceived risk of pertussis?  What about the feelings of guilt that may now be experienced by those who do venture out to the supermarket?

Whooping cough is a very serious disease that warrants increased public awareness and advice on how to prevent it, particularly in newborn babies.  Let’s make sure the advice we’re giving new parents on how to protect their baby is clear, and based on sound scientific evidence.

Parents can protect their baby by:

1) Avoiding close contact with people who have a coughing illness, and

2) immunising themselves, encouraging others who may be in regular contact with their baby to get immunised, and when the time comes making sure their baby (and their siblings) are immunised on time.

• Here’s a NSW Health fact sheet on pertussis for those who want more information

***

Swine flu was not nearly so bad as first feared

Another brick in the wall of understanding about the impact of the H1N1 influenza pandemic comes from a new study comparing antibody reactivity in specimens taken from healthy adult blood donors before and after the pandemic.

The study, reported in Eurosurveillance, found the proportion of influenza-seropositive donors increased from 12% to 22%. “This study suggests that exposure to the pandemic virus during the 2009 winter season was relatively uncommon among the healthy Australian adult population, at around 10%,” the researchers report.

They estimate that approximately 0.23% of all individuals in Australia exposed to the pandemic virus required hospitalisation and 0.01% died. The low seroprevalence reported suggests that some degree of prior immunity to the virus, they say.

Unfortunately the study was not able to distinguish the impact on Indigenous Australians. This is important as other evidence shows there was a marked geographic variation in the impact of the pandemic, with the NT having far higher hospitalisation and death rates.

The authors noted a number of limitations to their study, including that donors may not be representative of the broader population, and that children were not included.

***

Bugging the Commonwealth Games swimmers

Unfortunately, I’ve been a bit slow to put up this link to an article by public health physician and blogger Dr Craig Dalton regarding the gastro bugs recently suffered by the Commonwealth Games swimmers. His advice was to keep sick swimmers out of the water.

Hopefully it’s not too late to raise this issue though if there are any reviews held in the wash-up of the Games.

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