A case of pertussis (whooping cough) was confirmed in a child attending Chesterfield County Schools earlier this month. The incidence of this disease has increased in certain parts of the country within the last couple of years. Most severe cases have been in infants, less than five months of age. Children this age are susceptible because they are too young to have received all of the recommended booster shots. However, anyone who does not have adequate immunity to pertussis can get the infection.
Pertussis is a bacterial infection. In the 1920’s and 30’s there were about 160,000 annual cases of the disease, leading to 5,000 deaths a year. Since the TDaP (tetanus, diphtheria & pertussis) vaccine was introduced in the 1940’s, the incidence dropped 99% by 1976.
The current immunization schedule calls for TDaP vaccination at ages 2, 4, 6, and 15 months, upon entering kindergarten, and another booster at sixth grade. Families who choose not to vaccinate their children or haven’t kept up with their shots can risk exposing themselves and the community to pertussis infection.
There are several factors which may account for the rising numbers of whooping cough cases in recent years. Since we are more aware of possible outbreaks, doctors may be testing for pertussis more often. Additionally, the lab tests for diagnosing pertussis are now more accurate than in past years. Finally, there is overall improved reporting of the disease through state public health departments.
Pertussis is a respiratory disease, affecting the bronchial tubes. Initial symptoms occur 7-10 days after exposure and are similar to the common cold: runny nose, sneezing, occasional cough and low-grade fever. The cough gradually becomes worse over the next week or two leading to spasmodic coughing fits.
The patient has bursts of numerous, rapid coughs trying to expel thick mucus, followed by long inhalations and the characteristic high-pitched “whooping” as they try to catch their breath. Occasionally the patient will turn blue trying to get air, and commonly children will experience vomiting and exhaustion after these attacks.
Coughing attacks are more frequent at night with an average of 15 episodes per 24 hours. During the first 1-2 weeks of this stage, the severe episodes increase in frequency and then gradually decrease after 2-3 additional weeks. The coughing can last up to ten weeks. Children less than 6 months of age will have coughing spells, but may lack the strength to produce a “whoop”.
Persons who have been vaccinated but have weakened immunity may contract only a mild case of pertussis. A mild case has the appearance of a common cold. The worrisome complication of pertussis is a more severe bacterial pneumonia on top of the pertussis infection. This is the most common cause of death from whooping cough.
Infection with pertussis can be treated with antibiotics. However, the course of the disease can still be quite prolonged, particularly the cough. Individuals who have been in close contact with those diagnosed with pertussis can be placed on preventative antibiotics. Always consult your physician if you have severe or prolonged respiratory symptoms or if you have experienced a possible exposure to pertussis.
The content in this column is for informational purposes only. Consult your physician for appropriate individual treatment. Dr. Reynolds practices Family Medicine in Chesterfield.