Whooping Cough: Still a Threat

Nick, 54, who was vaccinated against the Bordetella pertussis bacteria in his early childhood, got whooping cough earlier this year. He recovered well, but his hacking cough continued for nearly two months, and forced him to stay away from his new granddaughter.

Highly contagious, whooping cough, also known as pertussis, was a major cause of childhood illness and death 100 years ago. Even though Nick was vaccinated in childhood, immunity fades over time, and many adults and adolescents fail to get the necessary booster shots.

The vaccination, now administered routinely to babies during their first 18 months of life, is effective, and proof of immunization is required of all children entering kindergarten unless they have a religious or other exemption.

Thanks to vaccination, prevalence of the disease reached a low of 1,010 cases in 1976, but whooping cough has been increasing since that time and has recently become a public health threat once again.

More than 13,000 infections were reported in 2008, and two years later California had its worst whooping cough outbreak in more than 60 years, with more than 9,000 infections and 10 deaths of infants under two months of age. This outbreak prompted a law, passed earlier this year, requiring all students in grades seven through 12 to get a booster vaccination. On a national level, the Centers for Disease Control recommended booster shots for all older children and adults, particularly those who will spend time around young children.

Immunization Schedule: The immunization schedule, established by the Centers for Disease Control, includes a series of five shots of diphtheria/tetanus/pertussis (DTaP) vaccine according to the following schedule:

      2 months,

      4 months,

      6 months,

      12 to 18 months, and

      A booster shot at 4 to 6 years

Booster shots for adolescents are recommended at age 11 to 12, and for adults every 10 years. These boosters have become increasingly important as a result of the recent outbreaks.

How is Whooping Cough Spread and What are the Symptoms?

Although very young children are at greatest risk of critical illness related to whooping cough, it’s the adolescents and adults who are most likely to transmit the disease. According to 2008 figures, only 41 percent of adolescents (ages 13 to 17) and only six percent of adults had received the required booster shots.

The disease usually starts innocently enough with typical cold symptoms: runny nose, nasal congestion, sneezing, a mild fever, and a dry cough. After a week or two, when a cold should be fading away, the symptoms get worse with severe and prolonged coughing that may bring up thick phlegm or even result in vomiting. Some patients sustain cracked ribs, abdominal hernias, or broken blood vessels in the skin or the whites of the eyes as a result of the strenuous coughing.

The disease gets its name from the high-pitched “whoop” sound that accompanies the breathing in of air just after a spasmodic bout of coughing. The characteristic cough may emerge relatively late, however, or not at all, particularly in infants under six months of age.

Treatment for Whooping Cough: An infant with whooping cough must be monitored constantly because of the potential for a temporary inability to breathe, known as apnea. Other danger signs include a blue skin-color due to lack of oxygen (cyanosis), and an abnormally slow heart rate (bradycardia). Parents should also be on the lookout for signs of dehydration such as reduced urination or crying without tears.

Facing a high risk of complications such as ear infections, seizures, brain damage, pneumonia, and death, most infants with whooping cough require hospital care. Antibiotics, prescription sedatives, and intravenous feedings are usually part of the treatment. An oxygen tent with high humidity may also be used. Cough medicines and suppressants are usually not very effective and not recommended.

Outcomes: Serious complications are rare in adults, and treatment during the latter stages–when the disease is most likely to be detected–does not often have a major effect on the course of the disease. Antibiotics, however, can shorten the duration of the infection and make it less likely to be passed along to a child who is more vulnerable to complications.

While immunization rates in the United States remain high (more than 90 percent), a child is not completely protected until after the third shot is given. As a result, infants under six months of age are vulnerable, given the extremely contagious nature of the disease.

Within a household, the disease is highly contagious, with the bacteria transmitted much as a cold virus is. From 76 to 83 percent of whooping cough cases in infants can be attributed to contact with parents, siblings or other close household members, according to one study.

Be Prepared: The Centers for Disease Control wants family members to be vigilant about immunization any time a new child enters the home. A 2008 recommendation urged mothers to get their immunization up-to-date before they leave the hospital or birthing center. Other family members, even grandparents who will spend time around the new baby, should also be immunized.

One major problem involves delays in the child’s recommended immunization schedule, which usually happens because a family lacks access to health care. When shots are not received according to the recommended schedule, a child’s risk increases.

Children who are given exemptions because of personal beliefs are also at higher risk themselves and lower the “herd” immunity of the community, making disease transmission more likely. One study found that children whose parents refused vaccines were 23 times more likely than other children to become infected.

Many Americans assume wrongly that whooping cough is a childhood disease that has been nearly eliminated through immunization. In fact, public health authorities say that brief outbreaks can be expected to occur every three to five years as vaccine-induced immunity wears off.

Coughing illness is common during the winter months and usually no cause for concern. It’s important, though, for parents to stay alert to the dangers of whooping cough, either in themselves or in their children. Quick action is essential to protect young children.

Addition Resources Available: Visit Sanjuanregional.com for more information about whooping cough.