Whooping Cough: Why You Need to be Concerned

If you’ve listened to the news lately, you’ve heard about whooping cough. Everyone, from babies to grandmas, has gotten it–no one is immune. Whooping cough–one of those diseases that seems like it should’ve been eradicated long ago–is back. And it’s scary. Breezy Mama turned to Pediatrician Dr. Jon Conti for the low-down on this infectious disease.

What exactly is Whooping Cough?
‘Whooping Cough’ is a highly contagious, vaccine-preventable bacterial disease caused by Bordetella pertussis. It lasts for many weeks and typically manifests in children as raging spasms of severe coughing,  or ‘whooping’, and vomiting after the coughing episode has completed.

Why are we suddenly hearing about so many cases in the news?
For many people, pertussis (commonly known as Whooping Cough) is old news—a once-feared disease long controlled by vaccination. The perception that pertussis is something we don’t have to worry about obscures the fact that, despite effective vaccines and generally high coverage, pertussis remains a stubborn public health threat, more prevalent and severe than is commonly recognized. Over the last two decades in the United States, deaths have actually increased among infants too young to be immunized.

So why are we hearing about in the news lately?  Likely it is a combination of factors such as lower vaccination rates, a waning of communal immunity against pertussis in adolescents and adults, and the fact that it is a cyclic disease.

Is it an epidemic?
Yes. The definition of an epidemic occurs when new cases of a disease occur at a higher than expected rate in a given population during a particular period of time. And we have that now.

For example, in California last year, 219 cases were recorded for the ENTIRE YEAR. In comparison, this year to date (as of July, 23, 2010), 1,496 cases of pertussis have been recorded, including six infants — all under six months of age —who have died from the disease.  During our last outbreak in 2005, we had 3,182 cases with eight deaths.

Whooping cough seems like one of those illnesses that was eradicated with vaccinations–is it coming back because parents aren’t being diligent about having their children vaccinated?
Pertussis is a disease that comes back around every 5 years or so, and when it does, it isn’t helped by lower vaccination rates.

Should all parents be vaccinated? Or only parents of children of a certain age(s)? And which ages?
Yes, all parents of infants and children should be vaccinated. Pregnant women especially should be vaccinated, either during pregnancy or after giving birth. Fathers need to be vaccinated too, preferably before the birth of their baby.

Further, any adults that work with children should consider revaccination. And finally, don’t forget the adolescents who are thought to be one of the major reservoirs for this disease (and one of our likely pools of babysitters).

I see ads in my parenting magazines targeted to parents–to have parents make sure they’re vaccinated, as well as their children. If we were vaccinated as a child, do we need to get a booster shot?
The short answer is yes. Immunity from the pertussis vaccine wanes after a period of years (5-10 years after vaccination and 7-20 years after natural infection). As you get older, you can still get ill and have a horrible hacking cough for weeks, but again most adults do okay with it. The risk is more to those infants and children that you are coughing on—particularly if you’re a parent or in the healthcare or education fields.

What ages are the biggest concern for it to be a threat for?
Infants and small children, especially those with chronic medical conditions like asthma, heart or immune systems. Babies who are too young to be fully vaccinated and those who have not completed the primary vaccination series are at highest risk for severe illness.

Infants aged younger than 12 months are at most risk for serious morbidity, including death, from pertussis. During the period of 2000-2004, 100 deaths due to pertussis were reported; of these, 90 deaths occurred in infants aged younger than 4 months. An average of 2,488 cases of pertussis among infants under 12 months were reported annually during the period of 2000-2004. Most of these infants—greater than 60%—required hospitalization.

The last time I checked, 5 children had died in San Diego alone–is this something that can be equally as contagious/fatal to adults?
Generally infants and children have a much more difficult time with this illness. However, the elderly and infirm can also be susceptible to this disease.

How does one get whooping cough–does it pass from one infected person to another?
Whooping cough is spread by droplets from sneezes or coughs. The attack rate in vulnerable household contacts is estimated between 80-90%.

What are the symptoms?
Pertussis starts off with the most infectious stage first: a runny nose and a mild cough for about 1-2 weeks. Then in the second stage the runny nose symptoms abate, and the cough persists. The cough will become longer and more frequent—so called paroxysmal. A person then gradually recovers during the third stage, which sometimes takes several months.

Early Symptoms
Often, symptoms start mild and are like a common cold:
• runny nose      • low or no fever
• sneezing         • mild cough

Symptoms after 1-2 Weeks
Symptoms can get worse fast and can last for months. They include bad coughing attacks that may lead to:
• vomiting                • problems breathing
• a red or blue face   • extreme tiredness
• a “whoop” sound   • sweating spells

Symptoms in Infants Are Different
Infants younger than 6 months old often do not have a typical cough. In the early stages, infants may:
• gasp or gag      • get very tired
• stop breathing    • have seizures
**These symptoms can get worse very fast.

How will a parent know if their child has whooping cough versus a common cough?
The word “pertussis” is from the Latin words for intensive cough. You won’t necessarily know the difference; that’s my job to figure out with hearing the infant/child’s history and the caregiver’s setting, performing an examination and, in some cases, testing.

If we suspect that our child has it, what should we do?
Bring the child into your pediatrician or family physician to have them properly evaluated.

What age should a child be taken directly to the ER if they get Whooping Cough?
Any infant or child who seems to be unable to catch his breath, or becoming tired from the effort of the coughing spells.

For all other ages, do parents take them to their pediatrician?
“Never worry at home alone.” If you are concerned, make an appointment.

If we have it, should we stay away from our kids (if at all possible)?
Sure, isolation is key. Meanwhile you can get treated with antibiotics to decrease the spread to others and have your children, infants and family (coworkers, etc.) around you also put on antibiotics to prevent them from getting it. But don’t forget the easiest thing of all when you’re ill: remind everyone to cover their mouths with the bend of their elbow when coughing and to wash their hands often.

How is whooping cough treated? How long does it run its course?
First question last. The Chinese call Whooping Cough ‘The 100 day cough’. Generally we think about 6 weeks for the coughing stage to pass.
The treatment depends upon the stage that it’s caught at. If you are treated during the runny nose stage, there is an opportunity to arrest or lessen the coughing stage with antibiotics. However once the coughing stage has started, the antibiotics do little to repair the damage from the bacterium. Yet antibiotics at this stage should be started to help decrease spread to other people. This is why our best defense is a good offense—vaccinate!

The cough is unbearable to hear, it sounds so painful–if our child does have it, how can we make them more comfortable?
It certainly is horrible to hear—Jennifer Lopez uses a recording of the cough in her public service announcement (see video above) for pertussis. As for how to make them more comfortable, I’m afraid I don’t have an answer for that.

A friend of mine was exposed to Whooping Cough and was told that she was contagious for 21 days–is this true?
If your friend does not begin antibiotics, every time she coughs she will expose those around her to this highly contagious and severe disease.  Hence 21 days (after the onset of the cough) of isolation (droplet precautions) is reserved for those adults whom appropriate antibiotics is not initiated.  However if she starts antibiotics, isolation decreases to 5 days after she initiates antimicrobial therapy.

Anything you’d like to add? Any other illnesses parents should be concerned about this year?
While most families have vaccinated their children, the number of parents refusing immunizations appears to be increasing in the United States. Children who are not vaccinated against pertussis are 23 times more likely to get the disease compared to fully immunized children. And an epidemic year, such as this, is not the time not to fully protect our infants and children against this horrid disease.

A recent polio outbreak in Tajikistan shows how vaccination rates and infection control are linked. The World Health Organization estimates that when immunization rates fall below the target level of 90%, so called ‘herd immunity’ breaks down and a dormant illness can reemerge. After the polio immunization rate went below 87%, Tajikistan became the first certified polio-free country to have a persistent polio outbreak, now with more than 560 cases reported. Further, asymptomatic polio-infected individuals are responsible for transmission of polio out of Tajikistan into neighboring Russia and Uzbekistan. The occurrence of polio in Tajikistan and spread within the region documents that global travel can result in polio occurring anywhere in the world where immunization rates are inadequate.

Here in the US, we are comforted by the fact that the Western Hemisphere was certified polio-free in the early 1990s.  However, polio immunization rates are lower than 90% in many areas due to concerns regarding vaccine safety, as well as a lack of concern about polio due to no recent experience in the United States. With increasing globalization, the United States could be just one asymptomatic traveler away from an outbreak.

Remember, always ask your own pediatrician for advice if you suspect something is wrong with your child.

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About Jon Robert Conti, MD FAAP: Dr. Conti earned both a BA in Psychology and a BS in Biological Sciences from the University of California, Irvine. He went to medical school in Michigan, and completed his pediatric residency from the Children’s Hospital of Los Angeles in 2001—consistently ranked by US News-‘Nation’s Best Hospitals’ since the 1990’s. Dr. Conti is Board Certified in Pediatrics & Adolescent Medicine and presently cares for patients & their families at Sea View Pediatrics in Laguna Hills & San Clemente. He can be reached for consultation at Sea View Pediatrics: (949) 951-KIDS (5437)

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  1. Hey Breezy… I had whopping cough when my son was 10 months old. I couldn’t believe it. I had a very mild but constant (at night too) cough for about two weeks before my cough turned very ugly. During that time my husband kept telling me to go to the doctor for my cough but since it wasn’t bad I didn’t… until it was too late. All I can say is that if you get a cough (even mild) that lasts more than 3 days and doesn’t turn into a normal cold… go to the doctor!


    A Message from the California Department of Health

    As of August 3, 2010, 2,492 cases of pertussis, including 7 deaths in young infants, have been reported in 2010 to the California Department of Public Health (CDPH). This is a 6-fold increase in cases from the same interval in 2009

  3. Not sure how much stock I’d put in a pediatrician who throws out the herd immunity argument despite the fact that the pertussis vaccine (and the injectable polio vaccine) do not prevent transmission of the disease. You can still get pertussis no matter how many vaccine doses you’ve had, and you can and will pass it on to others once you have it.

  4. EXCELLENT and very informative article! One of the best I have seen. Thank you for sharing this information.

  5. California Department of Public Health
    Pertussis Report UPDATE

     To date (8/31/2010), there have been 3,600 confirmed, probable and suspect cases of
    pertussis reported in 2010 for a state rate of 9.2 cases/100,000. This is a 7-fold
    increase from the number of reported cases during the same time period in 2009 when
    501 cases were reported.

     This is the most cases reported in 52 years since there were 3,837 cases reported in
    1958 and the highest incidence since there were 9.3 cases/100,000 in 1963.
    Previously, the peak was in 2005 when there were 3,182 cases reported.

     177 (12%) cases have been hospitalized (of the 1,442 cases with known hospitalization
    information). 106 (60%) of hospitalized cases were infants <3 months of age and 132
    (75%) were infants <6 months of age.

     8 deaths have been reported, 7 were in infants <2 months of age at time of disease
    onset and had not received any doses of pertussis-containing vaccine. One was an ex-
    28 week preemie that was 2 months of age and had received the first dose of DTaP 11
    days prior to disease onset. The majority of infant cases in 2010 have occurred in
    infants <3 months of age.
     The median case rate by county is 7.7 cases per 100,000 (range 0-121).

     Rates are highest in infants <6 months of age (168 cases/100,000), in adolescents
    aged 7-9 years (28 cases/100,000) and 10-18 years (21 cases/100,000).

     Overall rates by race/ethnicity are highest in whites (7.7/100,000), however age-
    specific rates indicate that the highest rates are seen in Hispanic infants <6 months of
    age (199/100,000).

  6. tracy nelson says

    I am a nurse and I can say for a fact that the immunization Tdap does Nothing.Both of my teenagers received the vaccine ( NYS requires it to attend school) and yet they both tested positive for pertussis 4 months after receiving the vaccine.

  7. A new video about Whooping Cough by my friend and colleague Dr. Danielle Fischer, Vice Pediatrics chair at St John’s in Los Angeles.

  8. My son have all the signs of wooping cough . He went to the Dr last month the said it was a mild cold . But he has been coughing for about a month and its a dry cough . And its all day and all night !!! Sould I wait till Monday to set a app

  9. Hi Selina, Hope your son feels better! Call your pediatrician and ask their opinion.

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