The panic about an impending whooping cough epidemic has reached Plovdiv as well. After the first two cases announced last Friday, two more were added yesterday. Thus, the number registered so far is 4. The infected are two children aged 12, one aged 17 and one aged 5. They have not been placed for treatment in a hospital, as their infection is not severe, Dr. Tanya Uchordzhieva – head of the “Anti-epidemic control” department at the RZI – Plovdiv, informed “Maritsa”.
Of those newly infected with whooping cough, one is a fifth-grader at “Chernorizets Hrabar” Secondary School, and the other is a girl of the same age from Asenovgrad, who studies at “Dimitar Matevski” Secondary School under the hills. Their contacted classmates are under quarantine for 2 weeks, starting from April 18, when the cases were registered, explained Dr. Milena Panayotova, head of the Directorate “Supervision of Communicable Diseases” in the health inspectorate.
The restrictive measures in the schools provide for at-risk children to enter the buildings separately, they conduct their classes in only one office and eat in a place designated for the purpose. School nurses monitor their condition. The situation is the same with the school in Asenovgrad, where the 17-year-old patient studies.
All infected children in Plovdiv and Asenovgrad have been vaccinated
“All are vaccinated, with full immunization status, and this is the reason why the disease is milder,” explained Dr. Uchordzhieva. She added that the 5-year-old child has not attended a daycare center for a long time, and therefore there is no risk for other children from his nursery. At the same time, many parents ask why the immunized also get the disease.
“The reason for infecting vaccinated children is that in the last ten years, a cell-free, killed vaccine has been introduced, which is safer for the immunized, but
her immunity runs out faster.
It doesn’t go away completely, but it’s not as strong as it was in the beginning. That’s why children get infected later, at school age, but they take it more lightly,” explained Dr. Uchordzhieva.
The other reason she gives for the activation of whooping cough is that during the COVID pandemic there were very strict measures against airborne infections such as whooping cough.
“In the epidemic situation, we wore masks, kept our distance, used disinfectants, and now, when we relaxed, chicken pox and scarlet fever have become active, now also whooping cough,” explains Dr. Uchordzhieva, explaining the emergence of forgotten infections. However, she reassures that children without full immunization status are not allowed in kindergartens and nurseries, good hygiene is observed and monitored, so parents should not have any worries in this regard.
However, she is convinced that the epidemic situation from North-West Bulgaria will also come to Plovdiv and the cases on a national scale will be more. “We are monitoring the situation and are ready to react to any developments.
With the activation of the infection, GPs are cautious
and they can easily recognize whooping cough,
although the clinical picture is not quite typical in children who are immunized. So far, the characteristic suffocation has not been observed, the symptoms are milder and attention should rather be paid if the cough lasts more than two weeks. At this stage, the specialists have already been alerted, and we have sent letters that whooping cough is already spreading in Bulgaria. If there is any doubt, GPs and pediatricians can direct parents to examine their child or come to us and we will send the sample to the National Center for Infectious and Parasitic Diseases in Sofia, which we always do,” says Dr. Uchordzhieva. According to <210>, the procedure can also be performed by personal physicians.
The sample is through nasopharyngeal secretions,
from which the causative agent itself is isolated, and this is the most indicative study. “Jeeps can take this secretion. There are no specifics for either the storage or the transportation of the sample. There are no special requirements for them to comply with. The samples can be taken at our place, at the Inspection, as well as at one of the laboratories in the city,” says the doctor. She explains that it is important that general practitioners and pediatricians have the attitude to think about this disease, even if it does not have the typical clinical picture.
“I’m glad my colleagues are doing it. So far, we have had a few suspected cases which fortunately have not been confirmed. This is the better option than monitoring only the typical symptoms,” the RZI specialist is convinced.
The epidemic is knocking on the door, in Sofia it is most critical
After the whooping cough boom in European countries such as Germany, England, Spain and neighboring Greece and Romania, whooping cough, as the infectious disease is also known, not only crossed borders, but spread like wildfire. 200 people have already been registered in the country since the beginning of the year, while last year for the same period of time the infected were less than 10. In our country, for the moment, the infectious disease circulates most intensively in Sofia, the western part of the country, the first cases were reported in Burgas and Veliko Tarnovo, and in Kyustendil a few days ago the infection claimed the lives of two babies. Plovdiv did not lag behind and already recorded the first four cases of infection. The speed with which the infection spreads also raises concerns, which was confirmed by the chief state health inspector, Dr. Angel Kunchev, according to whom it is difficult to predict how far the scale of the spread will reach. The fact that, according to infectious disease experts, the number of sick people is most likely much higher, but because of the mandatory vaccines, the disease does not proceed with the characteristic severe symptoms and is more difficult to recognize, also causes concern.
We keep a high percentage of immunized, pregnant women also want
Those vaccinated against whooping cough in 2023 are 94% of all those subject to immunization. 91% revaccinated their children after the first year, and reimmunization was done to 87% of six-year-olds. For 12-year-olds who had the diphtheria, tetanus and pertussis vaccine, the rates were 88%. This was announced for “Maritsa” by Dr. Tanya Uchordzhieva, head of the “Anti-epidemic control” department in the inspection.
“We’ve had a lot of inquiries from parents with babies who want to be immunized because of all the media coverage and interviews. Pregnant women also ask, and three expectant mothers have passed through our office. Many of them, however, are most likely immunized by their personal doctors,” says Dr. Uchordzhieva. Although pertussis vaccines are mandatory, there have always been anti-vaccination sentiments, but the percentages for Plovdiv and the region are high.
Infectious disease specialists recall that the immunization scheme for children in Bulgaria against whooping cough includes immunization with the 6-valent vaccine at 2, 3 and 4 months. It is combined against diphtheria, tetanus, pertussis, hepatitis B, polio and Haemophilus influenzae type b.
According to the current mandatory immunization calendar in the country, immunization is carried out in three consecutive doses: second, third and fourth month. There should be a minimum interval of 4 weeks between receptions.
After one year, 5-valent vaccine is given, 4-valent is given at 6 years and the last immunization with 3-valent vaccine is given at 12 years. All of them include protection against whooping cough, also known as whooping cough, experts say.
The Ministry of Health has already sent letters to the regional health inspectorates and the Bulgarian Medical Union requesting that the general practitioners check the immunizations and reimmunizations carried out.
Doctors from Pazardzhik:
The children of immigrants and anti-vaxxers are at risk
Dr. Dimitar SavovDr. Dimitar Savov
There is not a single patient with whooping cough in Pazardzhik – neither an adult nor a child. This was the case at least until yesterday, but RZI experts admitted that they do not rule out the possibility that the data could change. How surprisingly they changed in the country – a disease that we had almost forgotten returned.
“I don’t remember ever in my practice ever meeting a patient with whooping cough,” admits Dr. Hyulya Sherif, who heads the Department of Infectious and Parasitic Diseases at the RZI – Pazardzhik. She adds that there is a very high immunization coverage in the region, but the children of emigrants may be a problem. At the first needle, while they are babies, the vaccine is given almost without exception, but with reimmunization at a later age, the percentage is lower.
“For over 30 years of medical practice, I have never seen a patient with whooping cough,” says the director of the Health Inspectorate, Dr. Dimitar Savov, who until recently was part of the team of the Regional Hospital, the largest in the region.
Dr. Savov assures that no additional measures are required for now. GPs have been ordered to review their charts and if there are any missed vaccinations, make them up. He does not rule out that modern anti-vaccine currents have also affected whooping cough immunizations, although there is no evidence of a total rejection, as is observed with other vaccines. The experts from RZI have more than once seen parents who submit a declaration of refusal, pay their fines and do not allow their children to be immunized. For this purpose, some even lie that the little ones are sick and their vaccine is contraindicated. In such a case, a committee of doctors assesses the extent to which this is the case. We saw the consequences of this resistance in the measles boom, and the medics are praying that history does not repeat itself with whooping cough.
Dr. Sheriff preemptively advises people with doubts to isolate themselves or at least keep their distance. Whooping cough is a droplet infection and responsible behavior can stop its spread.
Author: Dora Tsvetkova
In Smolyansko, adults are also being urged to get vaccinated
Dr. Siika Cherneva
Since the beginning of 2024, there have been no registered cases of whooping cough in the Smolyan region, reported Dr. Siika Cherneva, head of the Directorate “Supervision of Infectious Diseases” at the RZI. However, the call of experts from the health inspection is for children to be immunized in a timely manner, as well as pregnant women up to the 36th week of gestation, in order to protect newborns. “For adults, there is also a vaccine in the pharmacy network, and it is recommended that grandparents and parents get the vaccine when they have a baby at home,” said Dr. Cherneva.
She pointed out that last year in the region, with regard to the mandatory vaccines of the first admissions, the coverage was good – from 96-98 percent, with reimmunization at 16 months of age, the coverage was 95%, but then it makes an impression that at the age of 6 and age 12 the range drops to about 86%. “That’s why we urge parents to take their children for immunizations, because whooping cough is an acute respiratory infection that is transmitted by airborne droplets, and no one is immune,” said Dr. Cherneva. She noted that adults who were vaccinated against whooping cough as children should also be re-immunized, especially if they have a baby at home, as it is not clear whether they have sufficient antibody protection against the infection after so many years.
