Not Just Your Grandparents’ Pertussis: Whooping Cough Today

What crosses your mind when you hear the words “whooping cough?” Perhaps you think it’s one of those diseases our grandparents had to worry about and is no longer relevant to us. Maybe you think it’s another one of those darn viruses that just has to pass on its own. However, both of those are misconceptions.

The proper name for whooping cough is pertussis, and it is caused by a bacteria. It is a vaccine-preventable disease that is still alive and well in our community,  largely affecting babies more than older children or adults. Babies can actually die from a pertussis infection. Unfortunately, the number of cases of pertussis is growing nationwide.

One of my patients was recently diagnosed with pertussis. Here is her mother’s story on the experience of having a child who has been diagnosed with pertussis.

 

“Natalie was born Feb. 18, 2012 and was a very healthy, happy baby. At about two and a half months, she started to develop a cough. We didn’t think much of it since she has two older siblings and they had a cough at the time too. We figured it would go away on its own.

One morning, I woke up to Natalie making a strange sound in her bassinet. When I got up to check what was going on, I could tell she was struggling to breathe. My husband and I tried to arouse her so she would wake up and take a good breath. She was very lethargic and still struggling, so I called 911. As a nurse, I decided to give her a gentle, but strong, sternal rub to see if it would arouse her. If that didn’t work, I was getting ready to give her CPR.

The sternal rub aroused her and I decided she was stable enough for us to take her to the emergency room ourselves. The ER doctor ordered us to have a chest x-ray and monitored Natalie for a few hours. The x-ray was clear and we were told to go home and follow up with the pediatrician the following day.

In the clinic the following day, we talked with the physician about Natalie and how she had been feeling in the weeks prior. When we told him that Natalie had been coughing for the past two weeks, he told us he was suspicious that it could be pertussis. She had received all of her immunizations to date and the rest of our family was current with immunizations, but a child isn’t fully protected until age five. The nurse took a sample from her nose and the physician started her on antibiotics right away. When the test results came in four days later, it was confirmed that Natalie had pertussis, otherwise known as whooping cough.

By this time, Natalie spent most of her days sleeping, which was OK because when she was awake she would have coughing spells. The physician went over signs and symptoms for us to watch for, and told us that the whole family would need to be treated with azithromycin to eliminate the whooping cough bacteria.

Later at home, Natalie started to cough and breathe very quickly. She was inconsolable and wouldn’t nurse. These were all signs the doctor had told me about and they warranted her having to go back to the hospital. The ER physician decided to admit Natalie to the pediatric unit and start an IV and nebulizer treatments to help with her breathing.

After four days in the hospital, we were released. The physician told us that her cough could and will more than likely stick around and that some days will be better than others.

If I could give advice to any parent, I would tell them to vaccinate their child and make sure that anyone caring for their children is vaccinated. It is your best defense against this disease.”

 

Pertussis typically begins with mild upper respiratory tract symptoms similar to the common cold. It then progresses to a cough and then usually to paroxysms of cough (“coughing attacks”), characterized by inspiratory whoop and commonly followed by vomiting. There usually isn’t a fever and if there is, it isn’t very high. For people who have received the pertussis vaccine, the cough may be mild or it can be the typical “attacks” with the “whoop” at the end of the attack. It is nicknamed the “100 day cough” because although it may only last 6-10 weeks, in half of teenagers, it will last more than 10 weeks!

The complications can range from inconvenient (not sleeping well) to severe, such as pneumonia and rib fractures. Pertussis is most severe for infants under six months of age. It may start out with gagging, gasping and periods of not breathing called apnea. It can cause seizures, brain damage and even sudden unexpected death. 92 percent of deaths from pertussis occur in babies less than four months of age.

We can treat pertussis with antibiotics, but that really only reduces the spread once the cough has started. If the antibiotics are started during the very early start of the disease, they can improve the course of the illness. This is why we will treat entire families if one person is found to have pertussis.

So what can you do to protect your children? Vaccinate! Not only does your baby need vaccines, all of the people who spend time around him or her do also. The normal vaccine schedule gives pertussis as part of the DtaP (diphtheria, tetanus and pertussis). We give this vaccine at two, four, and six months, after 12 months, and then again before kindergarten. It turns out that the protection from that series wears off and we now give another booster at age 11 or 12 along with the tetanus booster (Tdap). Most adults have not had a pertussis vaccine since they started kindergarten and we recommend all adults to receive a Tdap as well. If you are not sure if your last tetanus shot had pertussis with it, check with your doctor. Also make sure your daycare providers, grandparents, aunts, uncles, etc. are up to date on their vaccines as well.

If you would like more information on pertussis, I encourage you to visit the Sounds of Pertussis website.

By Dr. Shari Eich

Pediatrician at Avera Medical Group McGreevy Clinic, Sioux Falls

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