Abstract This health report focuses on the impact whooping cough has had from decades until now on Australia in form of incidences or number of cases

April 19, 2019 Critical Thinking

This health report focuses on the impact whooping cough has had from decades until now on Australia in form of incidences or number of cases. Large number of cases are recorded despite best health services and mostly every population is at risk. However, infants are identified as having more tendency to be affected.
Evidence in form of statistics was sourced through keywords like “Pertussis epidemiology” and “pertussis in Australia”. Statistics are collected from websites like The Department of Health, Australian Vaccination-skeptics Network Inc., and the Australian immunisation handbook 10th edition. The University of Sydney library (CrossSearch) was used to collect information about at-risk population using keyword “pertussis at risk population”.
Whooping cough or pertussis is a respiratory disease caused by Bordetella pertussis bacteria which is highly contagious. Australia has always been reported with high rates of pertussis in each state and territory (Choi, 2012). This report will cover the magnitude and distribution of pertussis in Australia. It affects all age groups but infants less than 6 months are the once who are at greater risk (“Pertussis vaccines for Australians”, 2016). Further, it emphasizes on the factors that lead to the occurrence of disease in infants and discusses how to prevent infants from being infected by whooping cough. Nurses play vital role in the promotion of vaccines.
Whooping cough and its cases
In Australia, cases of whooping cough have always been recorded from decades. Beginning from 1870, several deaths occurred due to this. Though the number of deaths with the increasing years from 1870 to 1970 decreased but there was always a surge seen at some point until late 1940s. From the year 1945, vaccines came to play. In 1953, introduction of mass vaccination brought the deaths to its minimal level in the preceding years (https://avn.org.au/information/vaccines-and-diseases/dtp/meryl/ ). For pertussis, DPTw vaccine was provided which stands for diphtheria and tetanus toxoids with whole-cell pertussis. There were a lot of changes made for when to get the vaccine like in 1994, an addition of pre-school vaccine was made to reduce school transmissions and in 2003, 18 months booster being replaced by adolescent’s booster due to increase in number of youngsters being affected (Campbell, 2012). However, in 1997 DPTw was replaced by DPTa which is acellular pertussis vaccine (Quinn, 2010).
The use of DPTw vaccine also led to positive changes in death cases as it reduced the number from 4000 in the period 1926-1945 to 21 in the period 1976-1995 (McIntyre et al., 1998). Though, DPTw decreased the mortality rate but, it had some short- term effects like fever, a bit of swelling or crying. When DPTa replaced DPTw it also had the same short-term effects but somehow, caused more serious side effects than DPTw like swelling of injection area that could reach a point of being operated. (https://avn.org.au/information/vaccines-and-diseases/dtp/meryl/ ).Between the years 1995 to 1997 an increase in the incidence rate ratio was seen as it elevated from 23.2 in 1995 to 58.1 in 1997. Whereas, the use of DPTa vaccine in 1997 has positive effect and decreased incidence rate ratio in the years 1998 and 1999 to 30.3 and 23.1. But, the effect of vaccine did not remain the same and again the whooping cough incidence rate ratio escalates in the year 2000 by 8.1 compared to 1999 and further increases up to 47.8 in year 2001. Again in the next two years, decrease in incidence rate ratio was observed which was trailed by upsurge in the incidences to 55.1 in 2005 up to 11.2 times higher than 2004 rate (Quinn ; McIntyre, 2007).
Hence, it was observed that epidemics of pertussis occurs every 3 to 4 years. Moreover, in an unvaccinated area the chances of being affected by pertussis increases whereas, in vaccinated area the number of deaths by pertussis becomes low (The Australian immunisation handbook, 2015).
Besides, a different pattern was observed from 2006 to 2012. It was seen that the rate decreased by 24 per 100,000 population between 2006 and 2007. Afterwards, only an upsurge was observed in the succeeding years as the rate reached 173.3 per 100,000 in 2011 from 66.8 in 2008 and in 2012 rate decreased to 107.6 per 100,000 population. (Pillsbury, Quinn ; McIntyre, 2014).
So, the highest annual incidence of notifications (173 cases per 100 000 population) was reported in 2011, with 38 732 notified deaths (The Australian immunisation handbook, 2015). It was estimated that after 2011 epidemics, next pertussis epidemic may happen in 2015 as epidemics of pertussis were estimated to occur every 3 to 4 years (Kovitwanichkanont, 2017).
Similarly, between years 2013 and 2017, maximum number of cases of pertussis was recorded in 2015 i.e. total 22542 in number. Whereas, year 2013 had 12367 notifications of pertussis and 2014 had 11864 cases. After 2015, the total noticed cases decreased to 20105 in 2016 and further declined to 12087 (https://avn.org.au/wp-content/uploads/2018/01/Pertussis-cases-by-year.jpg ). The saying that pertussis has always had been circulating in Australia (“Pertussis vaccines for Australians”, 2016), proved to be right because in the beginning of this year 2018, 537 cases have been recorded in the month of January in Australia (https://avn.org.au/wp-content/uploads/2018/01/Pertussis-cases-by-year.jpg ).
Social Determinants for infants (at-risk population)
Population at risk means “Specific group or subgroup that is more likely to be exposed, or is more sensitive to a certain substance than the general population” (http://www.businessdictionary.com/definition/population-at-risk.html). In case of pertussis, infants are population at risk. Infants are to be vaccinated at 2, 4 and 6 months, followed by 18 months aged vaccine and then at the age of 4. Later, school immunisation program provides the vaccine at age 7 (“Whooping Cough (Pertussis)”, 2017). Thus, infants are at peak of getting pertussis during their first 6 weeks (Choi, 2012).
It is said that 1 in every 200 infants with whooping cough dies, thus, it illustrates that infants are at high risk of pertussis (MacIntyre ; Menzies, 2017). In Australia, infants remain the most susceptible group for pertussis despite vaccinations received at 2 months because adequate immunity is not reached until second vaccine is given at 4 months (Kovitwanichkanont, 2017), thus, due to improper development of the immune system they are at high risk of getting a disease. To overcome, firstly, during pregnancy it is important that the women gets vaccinated so that the antibodies can transfer through the placenta and reach the foetus. Moreover, this vaccine can protect the infants until the infants gets their vaccine. Secondly, adults and adolescents meeting the baby can cause infection as well so it becomes important that with the mother, close relatives should also get vaccinated (Kovitwanichkanont, 2017). However, it is uncertain to think that all the parents will be aware about this, therefore, health literacy is an important determinant of health. Health literacy has many aspects associated with it, including poor health status, deaths or ability of the person to participate in health-related programs. The uptake of vaccines depends on health literacy (Lorini et al., 2017).
Low immunisation uptake is associated with parent’s education because educated mother is more likely to get her child vaccinated (https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-017-2890-y ). However, if parents are not aware about vaccines and its importance, it is essential that the parents are informed timely by their general practitioners or nurses about getting vaccines. Moreover, for education of the parents for vaccines, government must play a role and plan something like starting an education campaign on vaccine preventable diseases and informing them about vaccines that should be taken during pregnancy like for pertussis and inform them about the importance of vaccinations giving examples of situations that occurred or government should come together with the hospitals to provide material to the parents having or going to have a newborn (Chuk et al., 2009). Furthermore, government should come up with some policies for example, like a NO VAX, NO VISIT program was started through social media for infant protection by not allowing to meet the baby if the person is not vaccinated or fails to prove that they are vaccinated and this is only for the first 2 months as the infant gets their first DPTa when they become 2 months old (Carlson, Wiley & McIntyre, 2016).
It can also be said that infants are vulnerable to this because of overdue to vaccines i.e. not getting vaccinated on time (Chuk et al., 2009). The possible reason for that could be access to services as it effects once choice because if health services are far and transport availabilities are less and not cost effective in areas it becomes a barrier between the people and their services. Therefore, it is more likely to find large number of cases in such areas as dependency on cars increases that may be difficult for children, young and elderly people to use. In other words, it can be said that where they live has an effect because urban areas will have easy access to the health services than rural areas. (Keleher & MacDougall, 2016)
Moreover, money plays a significant role in providing oneself the services so people with poor working conditions and less paid jobs are less likely to provide their children with vaccinations because they may think of it as money wastage as they may not be aware of the positive outcomes of vaccinations and would prefer to save money or use for their daily living, food or housing. (Osborne, Baum & Brown, 2013).
Somewhat, acceptance also has a part in refusal to uptake vaccines since it is based on culture, beliefs or attitude. Likewise, hesitancy also affects slightly as hesitant people are ready for vaccinations but just require motivation and appreciation that they are on the right path ((Willaby, 2014).
Role of nurses
Health care professionals are the most trusted by parents for gaining accurate information about the vaccines so nurses have a vital role to play as they are the usual administrators of vaccines and therefore, could communicate with the parents and ask about their concerns related to vaccine. Later, the nurse could clarify the concerns raised by parents and encourage the parents that they are doing the best for their children. moreover, they should give information about the importance of vaccine and how it prevents such contagious diseases like influenza, pertussis or diphtheria. while responding nurses should consider the level of details parents are looking for as some may want a simple response while others may be looking for a more detailed answer (“Nurses Essential in Ensuring All Children are Protected with Immunization”, 2017). For accurate and relevant response, it becomes significant that nurse should have knowledge about it and are aware about the facts related to vaccines (“Nurses Role in Immunization Safety and Awareness”, 2015). Nurses can contribute most in this case because they are the one who have time and are likely to spend more time with the parents having an opportunity to build therapeutic relation with them, promote the use of vaccines (Hoekstra & Margolis, 2016). Moreover, handling the concerns with the right way can make a difference because nurses may come across with either acceptors, hesitant parents or refusers. Therefore, nurses should handle the situation accordingly. When having a conversation with vaccine hesitant, nurses should ask about their concerns and accept them and try not to dismiss, they can further discuss about both positive and negative effects of vaccines and show some graphics. On the other hand, nurses can try and ask for permission from refusing parents to talk and discuss briefly, as well acknowledge their concerns and not try to exaggerate vaccine benefits (Danchin & Nolan, 2014)

In conclusion, this report outlined the occurrence of pertussis over the last many years in Australia. Whooping cough cases are recorded annually and observed to have a large impact after every 3 or 4 years. It also analysed that social and economic aspects influence the uptake of vaccinations. Additionally, it explained the nurses’ role in addressing the fears of individuals and families related to vaccine