Editing Whooping cough (section)

==Prevention==
The primary method of prevention for pertussis is [[vaccination]].<ref>{{cite web|title=Pertussis {{!}} Whooping Cough {{!}} Vaccination {{!}} CDC|url=https://www.cdc.gov/pertussis/vaccines.html|website=www.cdc.gov|access-date=27 May 2017|url-status=live|archive-url=https://web.archive.org/web/20170526025248/https://www.cdc.gov/pertussis/vaccines.html|archive-date=26 May 2017}}</ref> Evidence is insufficient to determine the effectiveness of antibiotics in those who have been exposed, but are without symptoms.<ref name=Cochrane07>{{cite journal | vauthors = Altunaiji S, Kukuruzovic R, Curtis N, Massie J | title = Antibiotics for whooping cough (pertussis) | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD004404 | date = July 2007 | volume = 2013 | pmid = 17636756 | doi = 10.1002/14651858.CD004404.pub3 | pmc = 11322855 }}</ref> Preventive antibiotics, however, are still used frequently in those who have been exposed and are at high risk of severe disease (such as infants).<ref name=Update10/>

=== Vaccine ===
[[Pertussis vaccine]]s are effective at preventing illness<ref name=Cochrane2014/> and are recommended for routine use by the [[World Health Organization]]<ref name=WHO2007Vac>{{cite web|title=Annex 6 whole cell pertussis|url=https://www.who.int/biologicals/publications/trs/areas/vaccines/whole_cell_pertussis/Annex%206%20whole%20cell%20pertussis.pdf|work=World Health Organization|access-date=5 June 2011|url-status=live|archive-url=https://web.archive.org/web/20120324184124/http://www.who.int/biologicals/publications/trs/areas/vaccines/whole_cell_pertussis/Annex%206%20whole%20cell%20pertussis.pdf|archive-date=24 March 2012}}</ref> and the United States [[Centers for Disease Control and Prevention]].<ref>{{cite web|title=Pertussis: Summary of Vaccine Recommendations|url=https://www.cdc.gov/vaccines/vpd-vac/pertussis/recs-summary.htm|work=Centers for Disease Control and Prevention|access-date=5 June 2011|url-status=live|archive-url=https://web.archive.org/web/20110629042921/http://www.cdc.gov/vaccines/vpd-vac/pertussis/recs-summary.htm|archive-date=29 June 2011}}</ref> The vaccine saved an estimated half a million lives in 2002.<ref name=WHO2007Vac/>

The multi-component [[acellular]] pertussis vaccine is 71–85% effective, with greater effectiveness against more severe strains.<ref name=Cochrane2014>{{cite journal | vauthors = Zhang L, Prietsch SO, Axelsson I, Halperin SA | title = Acellular vaccines for preventing whooping cough in children | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 9 | pages = CD001478 | date = September 2014 | pmid = 25228233 | doi = 10.1002/14651858.CD001478.pub6 | pmc = 9722541 }}</ref> Despite widespread vaccination, pertussis has persisted in vaccinated populations. It remains "one of the most common vaccine-preventable diseases in Western countries".<ref name=":0" /> The 21st-century resurgence in pertussis infections is attributed to a combination of waning immunity and bacterial mutations that elude vaccines.<ref name=":0">{{cite journal | vauthors = Mooi FR, Van Der Maas NA, De Melker HE | title = Pertussis resurgence: waning immunity and pathogen adaptation – two sides of the same coin | journal = Epidemiology and Infection | volume = 142 | issue = 4 | pages = 685–94 | date = April 2014 | pmid = 23406868 | doi = 10.1017/S0950268813000071 | publisher = Oxford University Press | pmc = 9151166 | s2cid = 206283573 }}</ref><ref>{{cite journal | vauthors = van der Ark AA, Hozbor DF, Boog CJ, Metz B, van den Dobbelsteen GP, van Els CA | title = Resurgence of pertussis calls for re-evaluation of pertussis animal models | journal = Expert Review of Vaccines | volume = 11 | issue = 9 | pages = 1121–37 | date = September 2012 | pmid = 23151168 | doi = 10.1586/erv.12.83 | s2cid = 10457474 }}</ref>

Immunization does not confer lifelong immunity; a 2011 CDC study indicated that protection may last only three to six years. This covers childhood, which is the time of greatest exposure and greatest risk of death from pertussis.<ref name=JAMA2010/><ref>{{cite journal |vauthors=Versteegh FG, Schellekens JF, Fleer A, Roord JJ | title = Pertussis: a concise historical review including diagnosis, incidence, clinical manifestations and the role of treatment and vaccination in management | journal = Rev Med Microbiol | year = 2005 | volume = 16 | issue = 3 | pages = 79–89 | url= http://www.revmedmicrobiol.com/pt/re/revmedmicrob/abstract.00013542-200508000-00001.htm | doi=10.1097/01.revmedmi.0000175933.85861.4e| s2cid = 71775827 }}</ref>

An effect of widespread immunization on society has been the shift of reported infections from children aged 1–9 years to infants, adolescents, and adults, with adolescents and adults acting as reservoirs for ''B. pertussis'' and infecting infants who have had fewer than three doses of vaccine.<ref>{{cite journal | vauthors = Mattoo S, Cherry JD | title = Molecular pathogenesis, epidemiology, and clinical manifestations of respiratory infections due to Bordetella pertussis and other Bordetella subspecies | journal = Clinical Microbiology Reviews | volume = 18 | issue = 2 | pages = 326–82 | date = April 2005 | pmid = 15831828 | pmc = 1082800 | doi = 10.1128/CMR.18.2.326-382.2005 }}</ref>

Infection induces incomplete [[natural immunity]] that wanes over time.<ref>{{cite book|title=Disease Control Priorities in Developing Countries|edition=2nd|date=2006|veditors=Jamison DT, Breman JG, Measham AR|display-editors=etal|url=https://www.ncbi.nlm.nih.gov/books/NBK11728/|chapter=Vaccine-Preventable Diseases|vauthors=Brenzel L, Wolfson LJ, Fox-Rushby J|display-authors=etal|at=[https://www.ncbi.nlm.nih.gov/books/NBK11768/table/A2667/ Table 20.1 Selected Vaccine-preventable Diseases and Vaccines]|chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK11768/|publisher=International Bank for Reconstruction and Development, [[World Bank]]|location=Washington DC|pmid=21250343|isbn=978-0-8213-6179-5}}</ref> A 2005 study said estimates of the duration of infection-acquired immunity range from 7 to 20 years and the different results could be the result of differences in levels of circulating ''B. pertussis'', surveillance systems, and case definitions used. The study said protective immunity after vaccination wanes after 4–12 years.<ref name="pmid15876927">{{cite journal | vauthors = Wendelboe AM, Van Rie A, Salmaso S, Englund JA | title = Duration of immunity against pertussis after natural infection or vaccination | journal = The Pediatric Infectious Disease Journal | volume = 24 | issue = 5 Suppl | pages = S58-61 | date = May 2005 | pmid = 15876927 | doi = 10.1097/01.inf.0000160914.59160.41 | s2cid = 45434262 | doi-access = free }}</ref> One study suggested that the availability of vaccine exemptions increases the number of pertussis cases.<ref name="pmid24328666">{{cite journal | vauthors = Yang YT, Debold V | title = A longitudinal analysis of the effect of nonmedical exemption law and vaccine uptake on vaccine-targeted disease rates | journal = American Journal of Public Health | volume = 104 | issue = 2 | pages = 371–7 | date = February 2014 | pmid = 24328666 | pmc = 3935668 | doi = 10.2105/AJPH.2013.301538 }}</ref>

Some studies have suggested that while acellular pertussis vaccines effectively prevent disease, they have a limited impact on infection and transmission, meaning that vaccinated people could spread pertussis even though they may have only mild symptoms or none at all.<ref>{{cite journal | vauthors = Srugo I, Benilevi D, Madeb R, Shapiro S, Shohat T, Somekh E, Rimmar Y, Gershtein V, Gershtein R, Marva E, Lahat N | title = Pertussis infection in fully vaccinated children in day-care centers, Israel | journal = Emerging Infectious Diseases | volume = 6 | issue = 5 | pages = 526–9 | date = October 2000 | pmid = 10998384 | doi = 10.3201/eid0605.000512 | df = dmy-all | pmc = 2627963 }}</ref><ref>{{cite web |url=https://www.who.int/wer/2015/wer9035.pdf |title=Pertussis Vaccines:WHO Position Paper |date=August 2015 |quote=It is plausible that in humans, as in nonhuman primates, asymptomatic or mildly symptomatic infections in DTaP-immunized persons may result in transmission of B. pertussis to others and may drive pertussis outbreaks. |url-status=live |archive-url=https://web.archive.org/web/20160304110610/http://www.who.int/wer/2015/wer9035.pdf |archive-date=4 March 2016  }}</ref> Pertussis infection in these persons may be asymptomatic, or present as illness ranging from a mild cough to classic pertussis with persistent cough (i.e., lasting more than seven days). Even though the disease may be milder in older persons, those who are infected may transmit the disease to other susceptible persons, including unimmunized or incompletely immunized infants. Older persons are often found to have the first case in a household with multiple pertussis cases and are often the source of infection for children.<ref name=":1" />