Whopping Cough

Whooping Cough also known as Pertussis has been around for centuries. The disease was first described in the 16th century but the causative organism/bacteria was not discovered until 1906. In the last century, Pertussis was the most common childhood disease that contributed to the deaths of many children in the United States.

The first vaccine for Whooping Cough in the US was developed in the 1940’s. Prior to this, the number of deaths from Pertussis had reached 200,000 cases in the US alone. The vaccine reduced childhood mortality by 80%.  However, in 3rd world countries, where Public Health Services are minimal, Pertussis continued to claim the lives of many children. Data collated by the World Health Organization (WHO) in 2008, documented 195,000 deaths worldwide from Pertussis.

With the creation of a vaccine for Pertussis, the number of deaths from this disease in the US declined until 1959 when 40,000 cases were reported to the Centers for Disease Control. The formulation for Pertussis vaccine was changed in 1997 which increased the number of vaccinations from 3 shots to 5 shots for full immunization. Therefore, many children, teens, and adults immunized with the older version of the vaccine may account for the epidemic of Pertussis emerging over decades. In 2010 27,000 cases of Pertussis were reported to CDC with 27 deaths associated with this disease.

How Do You Know If You Have Whooping Cough?

With many parents opting out of immunization for their children, what are the risk factors for your child getting this disease? To begin with, most children “catch” Whooping Cough from adults who don’t know they have the disease. The early clinical findings are:

• Runny nose
• Nasal congestion
• Sneezing
• Red watery eyes
• Mild or no fever
• Dry cough

WOW, this sounds like a cold. However, a cold usually resolves in 7-10 days, with Pertussis the symptoms become more aggressive and extend beyond this window.  As the secretions/mucus thickens and accumulates in the lungs, the cough becomes uncontrollable and can be so severe as to cause vomiting.  The coughing is paroxysmal or bursts of rapid coughs are worse at night and can average between 15-20 attacks in a day. Whooping Cough is divided into stages which cover the entire course of the disease.

First Stage:

I like to call this stage the “runny nose phase”. The technical term is Catarrhal. Pertussis starts off with a runny nose, sneezing, low grade fever and a mild cough that is seen in the first 1-2 weeks after exposure. As the disease progresses into the 2nd week, the cough is more severe with paroxysms of coughing. This starts the beginning of the second stage.

Second Stage:

This stage is defined as the Paroxysmal Stage and is called this becomes the bouts of uncontrollable coughing. The coughing is worse at night and the bouts of coughing can prevent sleep, leave one short of breath, feel like one cannot breathe. With these extensive coughing episodes, the throat becomes irritated and can cause mild to moderate swelling or a condition called Tracheitis. This stage lasts from 1-6 weeks but can last up to 10 weeks. Again, between the bouts of coughing the individual does not look sick.

Third Stage:

This is the recovery or Convalescent stage. Recovery is gradual, can last up weeks to months. During this period paroxysms of coughing can still occur. Even when you are well again, it is not uncommon to see recurrence of paroxysm of coughing with respiratory infections for several months following recovery.

Complications:

Complications associated with Pertussis are related to secondary bacterial pneumonia that results in death. This complication is seen more frequently with infants younger than 6 months of age. Historical clinical data from 1997-2000, pneumonia occurred in 5.2% of all reported Pertussis cases and 11.8% of infants under 6 months of age.

What is the Treatment for Whooping Cough?

As with all illnesses, supportive medical management is the key. Treat fever, muscle aches/pain with Acetaminophen, Ibuprofen or Naproxen, increase fluid intake, and get plenty of rest. Antibiotics can eradicate Pertussis in secretions. Erythromycin is the drug of choice.   Alternative medications are Azithromycin (Z-Pac), Trimethoprin-Sulfamethoxazole (Bactrim). All household members should be treated with one of these antibiotics if a household member has been diagnosed with this infection. The best preventative treatment is immunization with Tdap for adults and DTaP in infants. Previous immunity against Pertussis wanes with age. For new parents to ensure all adults that come to visit to see the new baby have been immunized against Pertussis, insist on it as the life of your child may depend on it. If you are uncertain about your immune status to Pertussis, get the shot.