Whooping Cough

Jun 1, 2012
2012 / June 2012

Whooping cough, or pertussis, is a highly contagious respiratory infection caused by the Bordetella pertussis bacterium, which targets the lungs. Thick mucus forms deep inside the airways, leading to violent coughing episodes that make it difficult to breathe. Droplets transmitted in the air when an infected person coughs, sneezes or talks can spread the infection to others.

Pertussis used to be very common in the United States, affecting 200,000 people in epidemics occurring every few years. After the introduction of the pertussis vaccine and widespread vaccination of infants, this number drastically decreased. However, since neither the vaccine nor the infection provides lifetime immunity, outbreaks still occur in unvaccinated infants or adolescents and adults whose immunity faded. The Centers for Disease Control reported more than 27,000 cases of whooping cough in 2010, with many more unreported. The CDC no longer consider pertussis a childhood disease, since adults and adolescents contract it and pass it on to infants.

According to the World Health Organization, whooping cough is a major cause of infant death worldwide and continues to be a concern even in countries with high vaccination rates. The WHO estimated in 2008 about 16 million cases occurred worldwide, 95 percent of which were in developing countries, and about 195,000 children died from the disease. However, the CDC estimate 300,000 deaths per year worldwide. In June 2010, the State of California declared a whooping cough epidemic; that September, the California Department of Health reported 4,017 cases of confirmed, suspected and probable whooping cough, the largest number since 1955. In 2011, the Advisory Committee on Immunization Practices of the CDC updated its recommendations for pertussis booster shots.

At first, whooping cough seems like the common cold. Symptoms include a runny nose, sneezing, nasal congestion, watery eyes, mild fever and slight cough. One to two weeks later, the cough becomes severe, usually in spells lasting a minute or more and ending with a high-pitched whooping sound. The intense coughing can cause the person to fracture a rib, vomit, turn blue or pass out. This stage can last one to six weeks or longer. In time the cough improves, but it may linger in a less severe form for months. The infection is contagious as long as the cough is present, so it is important not to return to school, daycare or work until the cough is gone.

Most people recover with no problems. Complications tend to be side effects of the strenuous coughing such as bruised or fractured ribs, abdominal hernias or broken blood vessels in the skin or whites of the eyes. Infants and children younger than 2 may have ear infections, pneumonia, respiratory distress or arrest (slowed or stopped breathing), dehydration and even seizures or brain damage. Because infants and toddlers are at the greatest risk for complications, they more likely need treatment and hospital care and may be isolated to prevent infecting others. Whooping cough can be fatal in infants under 6 months.

Diagnosing whooping cough in its early stages can be difficult because symptoms resemble a cold, flu or bronchitis. Medical tests such as a nose or throat culture, blood tests and a chest X-ray confirm the diagnosis. Treatment for older children and adults (antibiotics) can usually be managed at home. Family members may be given preventative antibiotics. Over-the-counter cough medications have little effect.

Be sure to get plenty of rest and drink plenty of fluids to loosen mucus and avoid dehydration. Eat smaller meals to avoid vomiting after coughing. A room vaporizer or a warm shower or bath can soothe irritated lungs and loosen secretions. Keep your home free of irritants that trigger coughing such as tobacco smoke and fireplace fumes. Cover your mouth with tissues when you cough, dispose of them immediately and wash your hands frequently. Wear a mask around others.

The best way to prevent whooping cough is with the vaccine, often given in combination with diphtheria and tetanus vaccines. The DTaP (diphtheria, tetanus and pertussis) vaccine can be safely administered to infants. The CDC recommend a series of five vaccinations — usually given at ages 2, 4, 6 and 15–18 months and 4–6 years. Fully immunized children are usually protected from whooping cough. Infants too young to be fully immunized or who have received less than three doses of the vaccine are at risk. Anyone who has not been vaccinated or received a booster is also at risk.

Because immunity provided by the pertussis vaccine tends to decrease by age 11, providers recommend a DTaP booster at age 11. Many health care organizations recommend adults ages 65 and older receive the adult form of the pertussis vaccine. Some varieties of the every-10-years tetanus and diphtheria vaccine also include protection against whooping cough and help reduce the risk of transmitting the disease to infants. Pregnant women or anyone in close contact with an infant should be vaccinated. The CDC recommend pregnant women receive the vaccine after 20 weeks gestation, which may give some protection to the infant during the first few months of life.

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