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Family Health
Whooping Cough (Pertussis) FAQ
What is Pertussis or Whooping Cough?
Pertussis is an acute infectious disease caused by the bacterium Bordetella pertussis. It is a very distressing condition, which may cause serious trouble in the lungs and more severe complications. The disease appears to have no distinct seasonal pattern, but may increase during summer and fall.
Who is most at risk for pertussis or whooping cough?
A new born infant has no immunity to whooping cough, and can get it any time after birth if they are not immunized. Most cases of whooping cough occur in children under five years of age. In some cases, older children and adults may also be affected.
Young infants are at the highest risk for acquiring clinical pertussis, and for associated complications (for more on complications see http://www.cdc.gov/nip/publications/pink/pert.pdf).
Older persons (older children and adults), and those who have been vaccinated against pertussis may become infected with B. pertussis, but usually have milder symptoms. Pertussis in these individuals may present as a persistent cough (> 7 days), and may be indistinguishable from other upper respiratory infections as the whooping sound is not usually present in these cases.
Even though the disease is milder in these individuals, they may transmit the disease to other susceptible persons, especially unimmunized and under-immunized infants.
What are the symptoms?
The disease has a catarrhal, a spasmodic (paroxysmal), and a convalescent stage.
- For the first-second week (the catarrhal stage), the cough is like an ordinary upper respiratory infection. There is inflammation of the mucus membrane, runny nose, sneezing, low-grade fever and a mild occasional cough, similar to the common cold. Gradually the cough becomes more severe.
- Anytime between the first and second week the paroxysmal stage begins. This is when Pertussis is usually diagnosed. The coughing becomes spasmodic and comes in bouts, initially more often during the night, but later during the day as well. The affected person will cough and their face will become red and suffused, the tongue will protrude and the eyes will begin to water. At the end of the bout, the affected person will take a deep breath and there is a prolonged croaking sound that is called a whoop. This sound is produced by the air entering through a partially closed glottis (entrance to the larynx). This sound gives the disease its name. The person will bring out sticky secretion from their nose and mouth, and very often will vomit. The bouts are very exhausting. There is an average of 15 bouts per twenty-four hours. During the first two weeks the bouts increase in frequency, remain relatively stable for the next two, and gradually begin to decrease in number and duration over the next few weeks. The bouts usually disappear in about eight to 10 weeks from the beginning of the disease. In immunized children, the disease is mild and a typical.
- In the convalescent stage, recovery is gradual. The cough becomes less paroxysmal and disappears over a 2 - 3 week period. However, paroxysms often recur with subsequent respiratory infections for many months after the onset of pertussis.
Due to the severity of bouts of cough, bleeding can occur into the eyes, from the nose, the lung and in rare cases, into the brain, resulting in convulsions. In many young children, lung complications such as collapse of a part of the lung are common because of the thick sticky nature of the secretions blocking the passage of air to a part of the lung. Other complications of the disease are a middle-ear infection, sinusitis, broncho- pneumonia, and prolapse of the rectum. Convulsions may also occur and in rare cases and there may be inflammation of the brain.
Fever is generally minimal throughout the course of pertussis.
What causes pertussis or whooping cough?
Pertussis or Whooping cough is highly contagious, caused by rod-shaped bacilli, Bordetella pertussis and Bordetella Para-pertussis. Of these, the first one gives rise to more severe infections. It is also associated with various adenoviruses, Para-influenza and respiratory viruses.
How is whooping cough or pertussis spread?
It spreads rapidly from one person to another through droplets emitted by coughing (both direct and airborne droplets of respiratory secretions) This is especially so during the catarrhal stage and the first two weeks of the paroxysmal stage (approx. 21 days).
What is the medical treatment for whooping cough?
The medical management of pertussis cases is primarily supportive, although antibiotics are of some value. Erythromycin is the drug of choice. This therapy eradicates the organism from secretions, thereby decreasing communicability and, if initiated early, may modify the course of the illness.
Erythromycin or trimethoprim-sulfamethoxazole prophylaxis should be administered for 14 days to all household and other close contacts of persons with pertussis, regardless of age and vaccination status. Although data from controlled clinical trials are lacking, prophylaxis of all household members and other close contacts may prevent or minimize transmission. All close contacts <7 years of age who have not completed the four-dose primary series should complete the series with the minimal intervals. Close contacts <7 years of age who have completed a primary series but have not received a dose of DTP or DTaP within 3 year's of exposure, should be given a booster dose.
Are there other things that can be done to treat a person with whooping cough (Pertussis)?
Good nursing care is essential to the treatment of whooping cough. The patient should be isolated from others and kept in a well-ventilated room. They should wear loose clothes and must be given plenty of liquids in between the attacks of coughing.
Orange juice is especially beneficial. It can be given diluted with warm water (50:50).
When the convalescent stage has been reached, the patient should be encouraged to spend as much time as possible outdoors.
Is there a vaccine for Pertussis?
In the 20th century, Pertussis was one of the most common childhood diseases and a major cause of childhood mortality in the United States. A vaccine became available against Pertussis in the 1940's. Before the vaccine, there were over 200,000 cases reported annually. Since 1980, after the vaccine became more widely used, there is an average of 4,400 cases reported per year (http://www.cdc.gov/nip/publications/pink/pert.pdf).
In the unimmunized populations in the world, Pertussis remains a major health problem among children. There is an estimated 300,00 deaths per year due to the disease.
Three acellular pertussis vaccines are licensed for use in the United States. All three vaccines are combined with diphtheria and tetanus toxoids as DtaP.
Acellular pertussis vaccine (DtaP) is recommended for all doses of the pertussis vaccination schedule. Whole cell vaccine (DTP) is no longer recommended for use in the United States.
The primary series of DtaP consists of four doses of vaccine, the first three doses given at 4-to 8-week intervals (minimum of 4 weeks), beginning at 6 weeks to 2 months of age. The fourth dose is given 6-12 months after the third to maintain adequate immunity for the ensuing preschool years. DtaP should be administered simultaneously with all other indicated vaccines.
Children who received all four primary doses before the 4th birthday should receive a fifth booster) dose of DTaP before entering school. This booster dose is not necessary if the fourth dose in the primary series was given on or after the 4th birthday. The booster dose increases protective antibody levels and may decrease the risk of school-age children transmitting the disease to younger siblings who are not fully vaccinated.
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