Pediatrician’s Perspective: Whooping it up — whooping cough in the Triangle

There are coughs and there are coughs. Some are annoyances, some signify important health problems, some interfere with sleep. But few coughing illnesses can compare with whooping cough, a disease that had become uncommon but that is now making a comeback.

It is exhausting to have a cough for a few days. But whooping cough has been called the 100 day cough. Can you handle one that lasts for months, or watch your child in an awesome display of desperation and air hunger as he tries to fit a breath of air into the paroxysm of coughing? Over and over, day after day, the whoop, the exhaustion. It’s a scary disease and can be a deadly disease, especially for the very young.

Whooping cough is back.

Back in the olden days—the 1930s and 40s—thousands of American babies died each year from whooping cough (whose medical name is pertussis, caused by a bacteria called Bordetella pertussis). With the advent of immunization, whooping cough became very uncommon. In 1976 there were only 1000 cases reported in our country. But the number of cases has steadily increased, and in 2005 there were 25,000 cases in the USA. Even now whooping cough leads to many hospitalizations and even deaths from asphyxiation, stroke, seizures, pneumonia, collapsed lungs, broken ribs.

The signs of whooping cough
In the past weeks, several cases of pertussis have been reported in the Triangle area. In older babies and children it starts with what seems to be a regular cold with an unremarkable cough. After a week or two the cough gets much worse. There are coughing spells or “paroxysms” that are often ended with a “whoop” as the child tries to pull air into his lungs at last. This stage can last for 6 weeks of longer. Then there is a convalescent stage when improvement starts. This stage can last weeks to months.

Very young babies—under 6 months old—may not present with the typical coughing spells and whoop. Sometimes they just act sick and have periods when they don’t breathe. The very young baby—0 to 3 months old—almost always needs to be hospitalized. Whooping cough is most common and most severe in these youngest babies, and this is the age-group in which most deaths occur. Older children and adults who were immunized as young children may also have a milder disease, but they can still give regular old whooping cough to others, will have a prolonged and significant cough, and will undoubtedly miss work or school.

How we get whooping cough
Whooping cough is very contagious. It is spread from person to person on respiratory droplets broadcast by coughs and sneezes. About 7 to 10 days after exposure, the next victim can come down with whooping cough. Whooping cough is most contagious during the earliest weeks—before the whooping begins—and it remains contagious for at least 6 weeks.

Although whooping cough can be tested for and to some extent treated, it is so like an ordinary cold in its early (and most treatable) phase that we often don’t think of testing for it. Treatment, if begun in the early stage, can make the disease get better sooner and it can reduce the chances of it being spread to others. Treatment begun later—after the cough becomes paroxysmal—will help prevent the spread of the disease, but the cough will persist.

Whooping cough in the Triangle
Dr. Fred Henderson of the division of Pediatric Infectious Diseases at UNC says that we always have some whooping cough around here. The reservoir is older children, teens, and adults, because their immunity has waned. The immunity achieved after getting immunized or getting the actual disease become becomes ineffective to fight off whooping cough after 5 to 15 years. The older children and adults, with their partial immunity, suffer a less severe illness than tiny babies, but it is still a significant and very distressing and exhausting disease, with loss of work time or school time and the potential for serious complications.

Prevention
Young babies can only be protected by reducing exposure, at least until they can be immunized themselves. Whooping cough immunization is part of our standard immunization program, with shots at 2, 4, and 6 months, 15 to 18 months, and 4-5 years. Though no immunization is perfect, these shots are pretty effective at containing whooping cough from mid-babyhood to late childhood (when the immunity starts to wane).

In the last year a new immunization has been introduced that can boost immunity in teenagers and adults up to age 64. It is called Tdap (tetanus, diphtheria, acellular pertussis) and can be given in place of the old Td shot, the regular old “tetanus shot.” This is great news for 2 reasons: teenagers and adults will be much less likely to get whooping cough themselves (and if you have had a bad cough of any kind lately, this will be welcome news), and the teenagers and adults will not be sources of infection to tiny babies. Dr. Henderson stressed that all new parents should get the Tdap to protect their vulnerable newborn. Anyone who works with young babies should also get the booster, and of course anyone who does not think they would enjoy several weeks of a terrible cough.

Whooping cough is coming back, but we don’t have to welcome it. We have the tools to stop it. Since it’s hard to diagnose—for the first week or so it looks like any other cold, and the test for pertussis is somewhat unpleasant—prevention is key. We can continue immunizing babies and now we can immunize everyone (up to 64 years of age). If a baby cannot be immunized for some reason, it is doubly important that parents and other older people in the baby’s world get immunized.