Whooping Cough (Pertussis)

What is whooping cough (pertussis)?

Whooping cough, or pertussis, mainly affects infants and young children. Caused by a bacterium, it is characterized by paroxysms (intense fits or spells) of coughing that end with the characteristic whoop as air is inhaled. Whooping cough caused thousands of deaths in the 1930s and 1940s, but, with the advent of the pertussis vaccine, the rate of death has declined dramatically. Recent epidemics have occurred in areas where vaccine rates have fallen. Even though pertussis vaccines are very effective, if pertussis is circulating in the community, there is a possibility that a fully vaccinated person can catch the disease.

What causes whooping cough?

Whooping cough is caused by a bacteria called Bordetella pertussis. It is spread through children from exposure to infected persons through droplets in the air. Once the bacteria is in the child's airways, swelling of the airways and mucus production begins. Usually, the disease starts like the common cold, with a runny nose or congestion, sneezing, and sometimes a mild cough or fever. Usually after one to two weeks, sever coughing begins.

Facts about whooping cough:

  • Although the disease can be prevented with the vaccine, it does still occur (because of the children who are not vaccinated).
  • Whooping cough is worse for children younger than 1 year.
  • In the U.S., 5,000 to 7,000 new cases are reported each year to the Centers for Disease Control and Prevention. 

What are the symptoms of whooping cough?

The disease usually takes one to three weeks to incubate, with the child usually passing through three stages. The following are the most common symptoms of whooping cough, according to each stage. However, each child may experience symptoms differently. Symptoms may include:

  • catarrhal stage (often lasts one to two weeks):
    • mild cough
    • low grade fever
    • runny nose
  • acute phase (may last for several weeks):
    • cough gets worse and comes in severe fits
    • cough is dry and harsh
    • cough ends with a whoop sound on inspiration
    • child may vomit with the coughing and appear to be strangling on the vomit
    • cough can be started by many factors, including feeding, crying, or playing
  • recovery phase (usually begins around the fourth week):
    • vomiting and the whooping cough cease first
    • the cough usually decreases around the sixth week, but may continue on occasion for the next one to 2 months

Whooping cough can last up to several weeks and can lead to pneumonia.

The symptoms of whooping cough may resemble other medical conditions. Always consult your child's physician for a diagnosis.

How is whooping cough diagnosed?

In addition to a complete medical history and physical examination, diagnosis of whooping cough is often confirmed with a culture (mucus, nasal secretions) taken from the nose.

Treatment for whooping cough:

Specific treatment for whooping cough will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • extent of the condition
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

In many cases, the child may be hospitalized for supportive care and monitoring. Sometimes, oxygen and intravenous (IV) fluids are needed until the child begins to recover. Antibiotic treatment (i.e., clarithromycin [Biaxin] or azithromycin [Zithromax], or a related antibiotic) may also be ordered by your child's physician.

Family members and other people who have been in close contact with the child usually are started on antibiotic therapy, regardless of whether they have received the vaccine or not.

Other treatment may include the following:

  • keeping your child warm
  • eating small, frequent meals
  • increased fluid intake
  • reducing stimuli that may provoke coughing

Preventing whooping cough:

Although a vaccine has been developed against whooping cough, which is routinely given to children in the first year of life, cases of the disease still occur, especially in infants younger than 6 months of age.

According to Centers for Disease Control and Prevention (CDC), there has been a dramatic increase in the number of cases of pertussis since the 1980s, especially in teenagers (10 to19 years of age) and in babies less than 5 months of age. The CDC recommends that children need five DTaP shots for maximum protection against pertussis. A DTaP shot is a combination vaccine that protects against three diseases: diphtheria, tetanus, and pertussis. The first three shots are given at two, four, and six months of age. Between 15 and 18 months of age, the fourth shot is given, and a fifth shot when a child enters school at four to six years of age. At regular check-ups for 11 or 12 year olds, a pre-teen should get a dose of Tdap. The Tdap booster contains tetanus, diphtheria, and pertussis. If an adult did not get a Tdap as a pre-teen or teen, then he should get a dose of Tdap instead of the Td booster. Adults should get a Td booster every ten years, but it can be given before the ten-year mark. Always consult your physician for advice.

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