Epidemic outbreaks ofwhooping cough in three regions of bulgaria - clinical and epidemiological investigations

Background: Pertussis (whooping cough) was an acute airborne infection, which affected more often children, especially sucklings. Inspite of pertussis vaccination programme in many countries around the world the disease continued to be a global problem of the present day. During 2008 and 2009 an epidemic outbreak of whooping cough was observed in Bulgaria. According to the data of National centre of public health and analysis 444 persons were affected in this time. Materials and methods: The object of the study were 85 children with pertussis aged between 10 days and 16 years in threeregional hospitals - Sofia, Pleven and Stara Zagora were investigated. 60 of them were under 1 year old, 16 of them were under 2 months - too young to be vaccinated. The diagnosis was made by clinical, epidemiological, laboratorial, serological and molecular biological investigations. Results: Severe and moderate clinical forms predominated. Infants under 6 months of age have atypical clinical course. A short catarrhal stage, gaggling and apnea appeared as early symptoms. Complications as bronchiolitis were observed in 3 children, pneumonia - in 4. Oral macrolides were administered in 69 patients. In 16 an intravenous Ampicillin was used because of refractory vomiting. All patients were recovered successfully. Conclusion: In our investigation patients under 1year old were more affected than others. That was to say these, who have no, or only some of the primary doses. Long lasting cough complicated with paroxysms, specific laboratorial combination of leukocytosis with lymphocytosis and data of missing or incomplete vaccination strongly suggested the diagnosis whooping cough.