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Pertussis (Whooping Cough)

DEFINITION:

An intense cough with difficulty breathing caused by the pertussis bacterium.

SYMPTOMS:

Congestion, cough and cold symptoms. The cough is mild at first but gradually worsens to the point where the child is coughing so hard and quickly that they have to forcefully inhale, making a whooping sound.

CAUSES:

A bacterium called Bordetella pertussis affects the upper airway.

CONTAGION:

This is a very highly contagious illness. Ninety-seven per cent to one hundred per cent of susceptible people will get the illness if exposed. Exposure is by respiratory droplets from coughing or sneezing. The incubation of pertussis runs from six to twenty days with an average of seven days.

DIAGNOSIS:

The diagnosis is made by the symptoms. Knowing that there was an exposure to an infected individual and the immunization status can be helpful. A blood test or rapid antibody test from a throat swab can confirm the diagnosis.

TREATMENT:

Antibiotics such as erythromycin or ampicillin will lessen the contagion of the effected individual but do not lessen the course of the illness once the illness is in the paroxysmal stage. Antibiotics can shorten the course if given in the catarrhal stage. Exposed, susceptible individuals should receive erythromycin and the vaccine if they are due according the vaccine schedule. For children in the paroxysmal stage, oxygen, hydration and nutrition are supportive until the illness passes.

OUTCOME:

Mortality can be as high as forty per cent in children under five months of age. Older children and adults will recover after a long bout of coughing.

DISCUSSION:

Pertussis is one of the most highly contagious illnesses. Once exposed, an unvaccinated child will almost certainly contract this disease. The symptoms of this illness are divided into three stages: The catarrhal, paroxysmal, and convalescent. The catarrhal stage begins after a six to twenty-day incubation period. It is characterized by cold symptoms such as congestion, mild cough, low-grade fever, and watery eyes. This stage lasts one to two weeks. Then the paroxysmal stage occurs. The cough becomes more severe. A child will forcefully cough multiple times followed by a deep inspiration which sounds like a "whoop". The coughing is so hard that it can cause vomiting. This stage lasts two to four weeks. After this is the convalescent stage. The coughing decreases in frequency and severity. This lasts one to two weeks. The cough may last months and may recur for years after exposure to cold viruses. The paroxysmal stage is the most dangerous. Complications such as pneumonia and airway obstruction with mucus can make breathing difficult. There can be a lack of oxygen causing seizures and coma. Treatment is helpful but not always curative. The only way to prevent contracting this illness is through vaccination. Vaccination for pertussis is part of the DaPT vaccine. The pertussis vaccine is very important and life saving. However, the original vaccine or old pertussis vaccine had some complications. It was known to cause high fevers, irritability, and seizures. Some people feared this vaccination and refused it, causing their children to be susceptible and promoting the spread of the disease. In 1975, Japan stopped using the vaccine due to bad press and the incidence of pertussis went from 500 cases and 10 deaths to 13,000 cases and 113 deaths. Fortunately, the side effects issue has been resolved. The reason for the side effect was due to a component of the vaccine called the whole cell. The vaccine was made by growing pertussis in broth. The pertussis would produce toxin and the whole bacteria and toxin would be used to make the vaccine. The new vaccine is called acellular, meaning that the whole cell is not used. Only the toxin and important parts of the bacteria that promote immunity but do not cause side effects are used. Now the reason to worry about seizures, high fever, or other significant side effects has been removed. The recommended schedule for DaPT is two, four, and six-months of age with a booster dose at fifteen months and four years of age. The pertussis component of the vaccine does not need to be given after seven years of age, however, new research is showing that that it may benefit society if older children and adults get booster doses with the Td (tetanus/diphtheria) every ten years.

ONE DOCTOR'S OPINION:

Now that the acellular vaccine is readily available, there is no reason not to vaccinate. This is a harsh, difficult, and potentially devastating illness that no child should suffer through. It is so contagious that if vaccine rates don't stay very high the illness will hit a community with a vengeance. There are still over 3,000 cases a year in the USA and this really needs to stop. Only through proper vaccination will this happen.