Episode 57: July 11, 2012
by Rob Lamberts, MD
This is an unnecessary article. It’s unnecessary because the disease I am going to talk about can be prevented. This disease affects infants and children, and it kills. I am talking about whooping cough, also known as pertussis.
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What Is Whooping Cough?
Pertussis is an infection caused by a bacteria named bordetella pertussis. The infection is spread through the air when a person coughs, which means that it is easily spread from an infected person to a susceptible one.
What Are the Symptoms of Whooping Cough?
A classic infection with pertussis goes through several stages:
Stage 1: Incubation: The incubation stage is the time when the infection is present but before symptoms show up, and it’s generally 7-10 days. This long incubation phase makes it difficult to tell where a person got the infection
Stage 2: Catarrhal: Catarrh comes from a greek word meaning “to run down,” and is just a fancy way of saying a person has a runny nose. I guess calling it the “snot phase” wouldn’t sit well with civilized professionals. This phase lasts 1-2 weeks, and looks pretty much like a common cold.
Stage 3: Paroxysmal: A paroxysm is a sudden violent attack of something, and in the case of pertussis it refers to sudden, severe episodes of coughing. This phase is what gives pertussis its common name, whooping cough. The infected person has long episodes of coughing, followed by a long, raspy “whoop” when they finally breathe in. The person gags, has difficulty catching their breath, and sometimes vomits from coughing so much. Untreated, this phase can last for a long time, from 2-6 weeks, with the cough being worst at the start of this phase.
Stage 4: Convalescent: In this phase, the person slowly recovers from the infection, but still has a milder persistent cough.
What Are Other Symptoms of Whooping Cough?
But much of the time, the presentation of pertussis doesn’t follow this classic course. There are two main ways people can deviate from this:
Atypical symptoms in adults: In adults, whopping cough can sometimes cause just a dry and persistent cough, although they can still have a milder “whoop” with the cough. The reason for the milder symptoms is probably because adults have larger airways than kids, and because most adults have some immunity to the infection.
Atypical symptoms in infants: Sometimes infants, especially younger infants, have a limited catarrhal stage, and less whooping with their cough. The bad news is that they have something more serious: apnea. Infants infected will have periods where they stop breathing. That is why pertussis has been one of the suspects for sudden infant death syndrome, or SIDS.
Pertussis is deadly, especially to infants under six months of age. You may have heard in the news lately about an epidemic in California which has claimed the lives of seven infants so far.
How Is Whooping Cough Diagnosed?
Pertussis is usually diagnosed by swabbing the nasal passages and looking for the bacteria using special antibodies. The hard part about making the diagnosis, however, is suspecting the illness in the first place. Most physicians, myself included, were trained in an era where we thought of pertussis as a defeated foe. But the truth is that the infection has been making a comeback for quite a while, steadily increasing over the past 20 years. One study showed that out of 150 adults with cough lasting over 2 weeks, 12 percent were infected with pertussis.
How Is Whooping Cough Treated?
The good news is that the infection is quite easy to treat once it has been diagnosed. It responds quite well to common antibiotics, with a decrease in symptoms and a reduction in contagiousness that is fairly rapid.
How Can You Prevent Whooping Cough?
But the heart of the issue with pertussis is that it can be prevented with a vaccine. But despite the vaccine, the disease has recently been making its comeback. First, the vaccine wears off after a while, and so people become susceptible to it again. For a long time, the last immunization came at age 5. That was because previously immunized adults get a milder disease. The problem is not in adults getting the infection, though; the main problem is with those adults transmitting the disease to under-immunized infants.
Now I know all of you may be expecting me to rant a little about the people who are refusing vaccinations for their kids. Even though these people do put their children at risk of getting and spreading the disease, the real problem occurs in children under 6 months--even those who have gotten vaccinated. Until the first three pertussis immunizations are given, a child is still susceptible to infection--an infection that could kill them. In my practice, I recently saw an infant under 2 months of age who got the infection before the first immunization could be given.
So as I just mentioned, the real problem comes from infected adults passing it on to infants, so if I am going to rant, it’s going to be to urge any adults--especially those who spend significant time around young children-- to get immunized against pertussis. If people would get vaccinated, there would be less infections, and with less infections, there would be less infants dying from this preventable disease.
So my final words are two Quick and Dirty Tips for whooping cough:
Tip 1: Get your children vaccinated with as quickly as possible. All children should get their third pertussis immunization at the 6 month visit.
Tip 2: All adults who spend any significant time around small children should get vaccinated as well.
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Let me once again remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
Catch you next time! Stay Healthy!