PicPod 88 is all about Pertussis in Paediatric Critical Care. Malignant Pertussis is, for intensivists, one of the most terrible conditions to treat, with a dearth of evidence, and but plenty of evidence of death.



For PicPod 88 we have spoken to James Cherry from UCLA. James Cherry is a medical institution. At 94 years old he is still going strong with an encyclopaedic knowledge of Paediatric Infectious Diseases, and is author of the seminal Feigin and Cherry’s Textbook of Pediatric Infectious Diseases.



First we hear of the history of pertussis vaccine, and the debate and controversy of “vaccine encephalopathy” in the 70s and 80s. We then discuss the pathophysiology of malignant pertussis: is the problem the white cells themselves, or is there another mechanism? What is the role of coinfection, either bacterial or viral?



We compare two papers: James Cherry’s paper from 2018, and the newly published 2025 UK paper from the 2024 outbreak in Archives of Disease in Childhood (conflict of interest alert 😊).



What is the role of exchange transfusion? What is a reasonable threshold to do this? Does it work? Can we say it works, or is it a correlation only? When should we do an exchange transfusion: is it a number, a clinical state, a trajectory, or all three?



Does vaccination work? What do the studies show on PICU admission, and PICU survival? Has Pertussis changed its phenotype in the past decades? Which antibodies are important, and in which ratio?



How do we address vaccine conspiracy theories, or can we actually get past them? What’s the future for Pertussis vaccines?



Pertussis comes around once every 3-10 years depending on vaccination rates. Be ready for the next one.



Links to sources:



Cherry et al: An Observational Study of Severe Pertussis in 100 Infants ≤120 Days of Age – PubMed



Calley et al: Characteristics and outcomes of children admitted to paediatric intensive care units with life-threatening pertussis infection in Great Britain 2023–2024 | Archives of Disease in Childhood



MAHA report: whitehouse.gov/wp-content/uploads/2025/05/MAHA-Report-The-White-House.pdf