Neglect by parents blamed for rise in whooping cough

November 22, 1993|By Jonathan Bor | Jonathan Bor,Staff Writer

Cases of whooping cough, once among the most feared of all childhood diseases, are climbing in Maryland and elsewhere partly because of parents' complacency.

Although public health authorities do not foresee epidemics approaching the huge ones of old, doctors say many infants and young children are needlessly at risk because they are slow to get their full complement of shots.

"The majority of the children who are getting this disease and are being hospitalized are inadequately immunized," said Dr. Neal A. Halsey, a specialist in pediatric infections at Johns Hopkins Hospital.

This year in Maryland, 138 cases were reported to the state health department through last week, compared with 38 at the same time last year and 52 cases by year's end. In all of 1991, 61 cases were reported in the state.

Nationally, there were 4,719 cases reported to the national Centers for Disease Control and Prevention by Nov. 5, compared with 4,000 in all of 1992 and 2,700 in 1991.

Whooping cough, the common name for pertussis, is a highly contagious disease caused by bacteria that live in the mouth, nose and throat. It causes severe spasms of coughing that can interfere with eating, drinking and breathing.

It derives its familiar name from the disturbing "whoop" sound that children make as they struggle to inhale after a long series of coughs. Children often vomit after furious bouts of coughing.

Because of advanced life-support techniques, pertussis deaths average fewer than 10 per year in the United States. But complications of whooping cough are relatively common.

Pneumonia is reported in 10 percent of the children who get pertussis, according to the CDC. For every 1,000 children with pertussis, 20 may have convulsions and four may develop inflammation of the brain.

Dr. Peter Strebel, a CDC epidemiologist, said the recent upturn may be a predictable stage of the disease's normal cycle, in which it surges every four years or so and subsides in the intervening years.

The cycles are not completely understood. But he said one possible explanation is that it takes a few years for the number of inadequately immunized people to accumulate to a level that can sustain an epidemic.

To further complicate the issue, the vaccine does not protect people forever. Once people reach adolescence, its protective effect begins to wane, leaving teen-agers and adults somewhat vulnerable to infection.

The disease rarely produces serious complications in this age group, making it easy to dismiss as a bothersome cold even though coughing can persist for several weeks.

But doctors say teen-agers and adults can transmit the disease to young children -- making it doubly important that parents get their children immunized on a tight schedule.

Children should get a series of five shots: at 2, 4 and 6 months, between 15 and 18 months, and between 4 and 6 years of age.

But Dr. Diane Dwyer, chief of disease control for the state Department of Health and Mental Hygiene, said only a third of Maryland's children have their fourth shot by the time they are 19 months old.

Dr. Julia McMillan, deputy director of the Johns Hopkins Children's Center, said the hospital has admitted five to 10 children with pertussis since the summer. Normally, she said, the hospital admits one or two children during a year.

"If all they're doing is coughing, then we don't ordinarily admit them to the hospital," she said. But occasionally, children who cannot eat or breathe are admitted so they can receive intravenous feedings or oxygen.

"The threat to the public is the risk to infants," said Dr. Frances Gmur, a pediatrician who practices in Timonium.

"It's the infants who get sick enough to need to be in the intensive care unit and sick enough to die from it."

Sometimes, babies cough so persistently they cannot catch a breath, she said.

"They can end up having cardio-respiratory arrest," she said.

"The heart stops; they can't get air in. That's how they die." Infants who cannot get enough oxygen also can suffer brain damage, she said.

In this century, the peak year for whooping cough was 1934, when 265,000 cases were reported in the United States -- more than 60 times last year's total.

A vaccine was introduced in the late 1950s, causing a steep drop in the number of cases.

The vaccine, which consists of the killed pertussis bacterium, is given in a solution that also includes vaccines against tetanus and diphtheria. Most children get a slight fever and become cranky for up to two days after the shots, and half develop soreness and swelling where injected.

In the early 1980s, concerns over more serious reactions caused some parents to withhold the vaccine. A study suggested that one out of 330,000 children suffered brain damage as a result of seizures caused by the vaccine -- a small but nonetheless frightening risk.

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