Since the beginning of spring, children with whooping cough have been detected in our city, especially infants under the age of 6 months, who cough with red faces and red ears, cough with unrestless fasting, cough restlessness, and cough family collapse...... In order to be able to scientifically deal with the current epidemic of pertussis in children, we need to understand the characteristics and prognosis of pertussis infection from the cognitive perspective. So as to implement reasonable household prevention and control measures.
The relationship between microbial infections and herd immunity
The pathogens of infectious diseases include various environmental microorganisms, including bacteria, viruses, mycoplasma, chlamydia, etc., when our body is infected by these microorganisms, the human body will immediately activate defensive measures to eliminate them, these measures include two aspects in a broad sense: one is to excrete the pathogenic microorganisms in the body by physical means (such as coughing, vomiting, Diarrhea and other ways), the second is that the immune function kills the microorganisms that enter the human cells, when the microorganisms are killed, the human immune function will produce memory, once it is invaded by the same or similar microorganisms again, it can quickly activate the immune function to produce a large number of antibodies and other effective anti-infective ingredients, and the pathogenic microorganisms are removed in time, this process is acquired immune protection. The immune protection obtained by this route is also called natural immune protection or passive immune protection; there is another way to obtain protection through vaccination, which is called immune protection or active immune protection; if both pathways have experienced (infected again after vaccination, or infected and vaccinated again), the protection produced is called heterozygous immune protection; in terms of the degree of protection and strength, it is usually heterozygous immune protection> natural immune protection > vaccination immune protection. The above discussion refers to the immune process after individual infection, if these individuals constitute a living group, such as a community, region, etc., the immune status of this population is called herd immunity, and its protective effect is significantly greater than the sum of all individuals, that is, herd immunity protection, that is, more than 2/3 of the individuals in the group have produced protective immunity, and will not be infected 1/ 3 individuals produce protection, and the final outcome is that the infected microorganism is gradually eliminated in this group, and at the same time, due to the lack of stimulation of the infected microorganism, the herd immunity level will gradually decline, and when the decline can not produce protection, the pathogenic microorganism will be epidemic again, so the pathogenic cycle of infectious diseases will be formed.
Immune protection and pathogenesis characteristics after pertussis infection
Studies have shown that the protection produced by either natural infection immunity through pertussis or vaccination does not last a lifetime, and according to the theory of herd immunity protection, there will be periodic spikes in infection. It is generally believed that the immune protection time of natural pertussis infection can last for 4-20 years, and the immune protection duration of pertussis vaccine is 4-12 years, but in fact, the protection rate of the vaccine will drop by 50% after 6-12 years of vaccination, and basically no protection can be produced. Our national immunization program stipulates that diphtheria-pertussis vaccine is given at 3, 4 and 5 months of age, and the protection of children is about 5-10 years. Therefore, people under 6 months of age and over 5-10 years of age are susceptible to whooping cough, and if they are at the peak of the epidemic at the trough of herd immunity, these two age groups are most susceptible to infection. However, due to the obvious difference in the immune maturity of children under 6 months of age and the elderly and adults, the clinical manifestations are very different: infants and young children are more likely to have typical spastic cough, severe disease, long course of disease, and even combined with pneumonia, encephalopathy, pulmonary hypertension and even life-threatening; Chronic bronchitis has become the main source of infection due to untreated treatment, resulting in a large number of infants and young children being infected.
How to correctly improve awareness and implement scientific prevention and control
First, abandon excessive anxiety and fear, and understand that the current epidemic is because the level of herd immunity protection in the area where we live is at a low ebb, and with the gradual enhancement of herd immunity, the epidemic of bacteria will inevitably be contained; For those who do not heal with sore throat, pertussis nucleic acid testing should be carried out in a timely manner for this group. Timely treatment; third, correct drug selection, because the current pertussis has a high resistance rate to macrolides (such as erythromycin), especially in older children and adults, sulfonamides can be preferred, such as compound sulfamethoxazole (cotrimoxazole), if sulfonamides are allergic, children over 14 years old and adults can choose fluoroquinolone antibacterial drugs, such as levofloxacin; for children over 6 months old or older children with sulfonamide allergy, azithromycin can be used; children under 6 months old can choose roxithromycin, Tropethamycin and other granules. The total course of treatment takes 1-2 weeks, and the drug should not be discontinued at will. Fourth, the implementation of treatment "sitting", that is, one person infected and the whole family take medicine. This is a critical step in breaking the chain of infection, and older children and adults often have no serious clinical symptoms, but they can carry pertussis bacillus for a long time, thus infecting infants and young children repeatedly. Fifth, timely identification of severe disease, for children under 3 months old, if the child has severe crampy cough, dyspnea, convulsions or even poor circulatory status, it is necessary to be hospitalized in time. Sixth, full immunization, when infants and young children are infected with pertussis, parents may think that there is no need to be vaccinated, in fact, this is unscientific, natural infection and then immunization can obtain heterozygous immunity This higher level of immune protection, so regardless of natural infection, it is recommended that children need to be fully immunized.
Our immune function is evolved from the long-term struggle with pathogenic microorganisms, and herd immunity is obtained with the adaptation of human socialization process, is the most powerful weapon to protect human health, and the interaction between it and pathogenic microorganisms maintains a dynamic balance, so it is normal for pathogenic microorganisms to be prevalent in a certain period, for generally susceptible children, repeated infections are the process of stimulating immune maturation, and with the growth and development of children, protective herd immunity will gradually form, so it is recommended that parents and friends do not need to be overly anxious, fear, cognitively correct parenting concepts, scientific parenting behavior. Specific to the current pertussis epidemic, there is no need to be nervous and panic, the family monitoring focuses on the elderly and adults around infants and young children, once the individual onset, the implementation of the standardized treatment of rational drug use by all family members, and at the same time the whole process of immunization of infants and young children, jointly build a herd immunity system, the overall prognosis of whooping cough is still very good!
Xin Yi (first from left) is doing ward rounds
Xin Yi (first from left) and his medical team discuss the patient's condition
Xin Yi, deputy director of the Department of Pediatrics of Yantai Yuhuangding Hospital
Expert Profile:
Director of the Children's Intensive Care Unit (PICU) of Yantai Yuhuangding Hospital
Deputy Director of the Department of Pediatrics, Deputy Chief Physician, Doctor of Pediatrics
Master's tutor of Shandong Second Medical University
Member of the Pediatric Intensive Surgery and Trauma Committee of the Chinese Medical Doctor Association
Member of the Children's Natural Disaster Committee of the China Rescue Association
He is a standing member of the Shandong Pediatric Intensive Care Physician Association
Youth member of the Pediatric Branch of Shandong Medical Association
Member of the Intensive Care Group of the Pediatric Branch of Shandong Medical Association
Vice Chairman of the Pediatric Intensive Care Branch of Shandong Health Care Association
Vice Chairman of the Pediatric Intensive Care Branch of Shandong Provincial Research Hospital
Youth member of the Children's Branch of the Chinese Association of Research Hospitals
Member of the Allergy Group of the Pediatric Immunization Branch of the Chinese Medical Doctor Association
Vice Chairman of the Immunization Program Branch of Yantai Prevention Society
Vice Chairman of the Pediatric Branch of Yantai Association of Integrative Traditional and Western Medicine
Member of the Pediatric Branch of Yantai Medical Association
Deputy Director of Yantai Children's Critical Care Center
Editor-in-charge: Zhang Ping