Whooping cough sounds like one of those old-fashioned diseases that only the heroines of Victorian novels get. But whooping cough, or pertussis, is a serious and sometimes fatal illness that has been on the rise in the United States in recent years, says Virginia Keane, associate professor of pediatrics at the University of Maryland School of Medicine and president of the Maryland chapter of the Academy of Pediatrics.
What is whooping cough?
A bacterial infection caused by the bacteria Bordetella pertussis. This bacteria only resides in human beings. It is passed by droplets if people cough on you. It has an incubation period of seven to 10 days. It has multiple phases. It starts like a bad cold. Then it gets much worse. You can get pneumonia and encephalopathy (a brain disorder). You can get a leukemoid reaction - that's an explosion of white blood cells. Then you get in the recovery phase. The whole thing can take six to 10 weeks.
Who is susceptible?
The people who are most susceptible are infants who haven't been immunized yet.
When do children get immunized for the disease?
The vaccine schedule is 2, 4, 6 months, 12 to 18 months. Then before preschool. Then there's another booster dose in adolescence that we ideally give at 11 years of age. Since November 2005, it's been recommended that adults get a booster every 10 years. It is combined with the tetanus shot.
Can patients have reactions to the vaccine?
Until 1995, we were using a whole cell pertussis vaccine that was causing high fevers and severe irritability in children. Now that we use the acellular vaccine, which is much purer, we rarely see bad side effects.
If you have had whooping cough, can you get it again?
Yes. Your immunity can wane.
How many cases are there each year in the United States?
In the 1990s we saw fewer than 1,000 cases a year. In 2004, we had a little over 25,000.
Why have the number of cases been on the rise?
We think that is because adults are acting as a reservoir for [the disease]. And the number of susceptible children is growing because parents are being misled by scientifically unsupported claims that vaccines are dangerous and are choosing not to have their children vaccinated. I know they think they are doing what is right for their children, but they are wrong. They are putting their own children and others at risk of getting preventable diseases like whooping cough.
What is the mortality rate for whooping cough?
It depends on the age group. A relatively healthy young adult is not at risk. Adults with immune deficiency might be. The ones that are at the highest risk are young infants. If they are not treated properly, the mortality rate can be around 10 percent. It depends on your age, immune status and at what point in your disease it is diagnosed.
What are the signs and symptoms of the disease?
It starts like a cold. But the cough gets worse and worse. You usually get a fever with it. The cough gets so bad you can't catch your breath. You can't stop, and when you try to catch your breath, it sounds like a whoop. Sometimes little children will throw up. They can turn quite blue.
When should someone seek medical attention?
With young babies, they seem pretty sick before they get the whoop. With adults, if you have a significant cough that hasn't gone away in three weeks, you should see your doctor. There are other causes, but pertussis is the one you should get tested for and treated for.
How is it treated?
It's treated with antibiotics like erythromycin, and recently we're using azithromycin - Z packs. But that's not approved for young infants.
What is the best way to prevent whooping cough?
The best way to prevent it is vaccinate your children early and often, and for adults in contact with children to be vaccinated every 10 years.
What percentage of the U.S. population has received the vaccine?
That's a moving target. Pertussis vaccine was started in the 1940s. So most adults have had some doses of it. Since 2005, it's been recommended they get their booster.
If you get a tetanus shot is the pertussis vaccine in it?
It should be in there. You shouldn't have to ask for it. But you should be told it is in there.