Whooping Cough by Dorcas M. Eaves, M.D., MSS, AACPE

Certification: Board Eligible General Surgery, American Board of Medical Quality

The disease was first described in the 16^th century, but the causative organism/bacteria was not discovered until 1906. In the last century, pertussis was the most common childhood disease that contributed to the deaths of many children in the United States.

The first vaccine for whooping cough in the U.S. was developed in the 1940s. Prior to this, the number of deaths from pertussis had reached 200,000 cases in the U.S. alone. The vaccine reduced childhood mortality by eighty percent.  However, in third world countries, where public health services are minimal, pertussis continued to claim the lives of many children. Data collated by the World Health Organization (WHO) in 2008, documented 195,000 deaths worldwide from pertussis.

With the creation of a vaccine for pertussis, the number of deaths from this disease in the U.S. declined until 1959 when 40,000 cases were reported to the Centers for Disease Control (CDC). The formulation for pertussis vaccine was changed in 1997 which increased the number of vaccinations from 3 shots to 5 shots for full immunization. Therefore, many children, teens, and adults immunized with the older version of the vaccine may account for the epidemic of pertussis emerging over the decade. In 2010, 27,000 cases of pertussis were reported to the CDC with 27 deaths associated with this disease.

How Do You Know if You Have Whooping Cough?

With many parents opting out of immunization for their children, what are the risk factors for your child getting this disease?  Most children “catch” whooping cough from adults who don’t know that they have the disease.

The early clinical findings are:

• Runny nose
• Nasal congestion
• Sneezing
• Red watery eyes
• Mild or no fever
• Dry cough

WOW, this sounds like a cold. However, a cold usually resolves in 7-10 days, whereas pertussis symptoms become more aggressive and extend beyond this window.  As the secretions/mucous thickens and accumulates in the lungs, the cough becomes uncontrollable and can be severe enough to cause vomiting.  The coughing is paroxysmal; these sudden bursts of rapid coughs are worse at night and can average between 15-20 attacks in a day. Whooping cough is divided into stages which cover the entire course of the disease.

First Stage:

I like to call this stage the “runny nose phase”. The technical term is catarrhal. Pertussis starts off with a runny nose, sneezing, low grade fever, and a mild cough within the first or second week after exposure.  As the disease progresses into the second week, the cough is more severe with paroxysms of coughing.  This starts the beginning of the second stage.

Second Stage:

This stage is defined as the paroxysmal stage which is characterized by sudden bouts of uncontrollable coughing. The coughing is worse at night and the bouts of coughing can prevent sleep, leave one short of breathe, and a feeling like one cannot breathe. With these extensive coughing episodes, the throat becomes irritated and can cause mild to moderate swelling or a condition called tracheitis. This stage lasts from 1-6 weeks, but can last up to 10 weeks.  Again, between the bouts of coughing the individual does not look sick.

Third Stage:

This is the recovery or convalescent stage. Recovery is gradual, can last weeks to months. During this period, paroxysms of coughing can still occur. Even when you are well again, it is not uncommon to see a recurrence of paroxysm of coughing with respiratory infections for several months following recovery.

Complications:

Complications associated with pertussis are related to secondary bacterial pneumonia that results in death. This complication is seen more frequently with infants younger than 6 months of age.  According to historical clinical data from 1997-2000, pneumonia occurred in 5.2% of all reported pertussis cases and 11.8% of infants under 6 months of age.

Treatment:

As with all illnesses, supportive medical management is the key. Treat fever, muscle aches, and pain with acetaminophen, ibuprofen or naproxen, increase fluid intake, and get plenty of rest. Antibiotics can eradicate pertussis in secretions. Erythromycin is the drug of choice.   Alternative medications are azithromycin (Z-Pak), trimethoprin-sulfamethoxazole (bactrim). All household members should be treated with one of these antibiotics if a household member has been diagnosed with this infection. The best preventative treatment is immunization with Tdap for adults and DTaP in infants. Previous immunity against pertussis wanes with age. For new parents, be certain that all adults that come to visit and see your new baby are immunized against pertussis; insist on it because the life of your child may depend it. If you are uncertain about your immune status to pertussis, get the shot.