DEAR DR. GOTT: I’m scared! We just had one confirmed case of whooping cough in our middle school. If the disorder is as contagious as I have been led to believe, has this person possibly contaminated everyone in the classroom, in the school, on the playground, on the school bus and everywhere else? What about us at home and what happens next? How can I protect the rest of my family? What if I wasn’t immunized as an infant? Could I get it, too?
DEAR READER: Pertussis (whooping cough) is caused by a bacterium known as Bordetella pertussis. It is highly contagious and spread by an individual coughing or sneezing infectious droplets through the air. In the past, those most commonly affected are infants and young children; however with a vaccine available to most children before they ever enter school, the higher percentage of cases are now found among adolescents and adults. The incubation period is between five to 10 days, with an upper limit of 21 days.
There are three stages to the disease. The first, known as the catarrhal stage, lasts up to two weeks. It is characterized by a runny nose, sneezing, mild cough and a low-grade fever – all symptoms we might disregard as they are so similar to the common cold.
Next comes the paroxysmal stage, the period when symptoms exacerbate or worsen. This can last between one to six weeks but can continue on as long as 10. The affected individual suffers from a longer-than-usual effort inhaling accompanied by a high-pitched whoop (thus the name). Infants and young children can appear extremely ill, truly distressed, and may vomit or have a bluish tint to their skin that can be downright frightening. The whoop noise is uncommon in those under the age of 6 months and in adults.
The third convalescent stage that follows may last for months. The cough will usually disappear but attacks can recur with subsequent respiratory infections. The disease can still be transmitted to those who haven’t been immunized or to infants who haven’t completed the immunization series.
Infants have an increased risk of developing neurological complications such as seizures and inflammation of the brain, likely the result of a reduction of oxygenated blood to the brain. Other less serious complications include dehydration, ear infections and a loss of appetite. Adolescents and adults will typically suffer a milder case than will infants and very young children. Younger patients also have a greater potential for complications than will older patients. The most common issue is a secondary bacterial infection. Pneumonia occurs in one of every 20 cases.
Diagnosis is made through the history and examination by a physician. Laboratory testing can be done by taking a specimen of nasal secretions from the back of the patient’s throat for analysis but testing can take time and antibiotic treatment is customarily begun prior to the return of the lab results. Some patients may have blood drawn that might reveal large numbers of lymphocytes to assist in the diagnosis. If positive, antibiotics such as erythromycin (E-mycin) may be helpful. The drug should be given to all household members and other close contacts of the patient regardless of age for a full 14 days to minimize transmission. Those younger than the age of seven should complete their DTaP vaccination series if they have not done so. A five-dose DtaP series is recommended, given at ages 2 months, 4 months, 6 months, between 15 and 18 months and lastly between the ages of 4 and 6 years. Following that, a booster should be given at age 11 or 12 and every 10 years following. Some health care organizations even recommend adults up to the age of 65 without a history of vaccination receive the vaccine. If it has been completed but has been longer than three years since that completion, a booster should be administered during an outbreak.
Pertussis was once a major childhood sickness and cause of many deaths in our country. When a vaccine was introduced in the 1940s, the number of reported cases fell dramatically. Then, since the 1990s, the number of cases has risen once again with children falling into the greatest age group, followed by older individuals. Today if a child has a documented case of pertussis, he or she will likely not require additional immunization; however, the diagnosis should be confirmed by laboratory evidence before making a firm decision whether or not to re-vaccinate.
Keep in mind that because an infant or individual of any age is immunized, this will not prevent him or her from getting the disorder. No vaccine is 100% effective. If whooping cough is in your community, there’s a chance any fully vaccinated person can catch it. If you have been vaccinated, the infection should not be as severe as if you weren’t. Up to 20% of all individuals receiving the full series will not be adequately protected. Do your homework. Bring your children’s immunization up-to-date. Request a booster if appropriate and for Heaven’s sake don’t panic. Just play it safe.
