Whooping Cough: Essential Information
10 Essential Facts About Whooping Cough
Whooping cough, or pertussis, affects people of all ages, sometimes even if they have been vaccinated.
By Jennifer J. Brown, PhD
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Whooping cough is a potentially deadly infection that's resurgent in the United States even though it is vaccine-preventable. Reported U.S. case numbers reached 28,639 in 2013, but public health officials say far more cases probably go undiagnosed or unreported.
The hallmark of the disease, also called pertussis, is a frightening, high-pitched whooping sound as people struggle for breath after extended coughing fits.
Outbreaks of whooping cough have been reported across the country, from California to Kansas, and have affected people of all ages, both vaccinated and unvaccinated. In some communities — Greenville, Michigan, for example — unvaccinated students have been barred from school due to fear that they could spread pertussis.
Your best defense against whooping cough is vaccination. But the vaccine is imperfect. Before the 2-month mark, babies are too young for vaccination but highly susceptible to the infection. While the vaccine does not protect everyone completely, if you've been vaccinated and you contract the illness, your whooping cough symptoms will be less severe and the illness will end more quickly.
Here are 10 additional facts you might not have heard about this common “childhood illness” that anyone can get.
1. Whooping cough is one of the most highly contagious infectious diseases.
After an incubation period of 5 to 21 days, a whooping cough infection becomes very contagious, on par with measles. Whooping cough spreads through bacteria-infected droplets that travel in an infected person’s breath. When you cough or sneeze, others may inhale the infectious bacteria and get sick. The infection starts spreading once coughing begins and continues to be infectious for about another three weeks, according to the Centers for Disease Control and Prevention (CDC).
If caught early, whooping cough can be treated with antibiotics. It's so contagious that your doctor may even prescribe preventive antibiotics for you when someone in your household has whooping cough.
But when it's diagnosed late, medications are unlikely to control the cough, notes the CDC. Over-the-counter cough medicines are of no help, according to the Mayo Clinic.
2. Whooping cough can kill you.
Whooping cough is sometimes lethal for babies, who can have seizures, stop breathing, develop pneumonia, or suffer brain damage. The illness killed 20 Americans in 2012; most of the victims were less than 3 months old. About 95 percent of pertussis fatalities worldwide are in developing countries, notes the World Health Organization (WHO). Of the estimated 16 million people the WHO estimates are infected with whooping cough, 61,000 died during 2013, according to the most recent data from the Global Burden of Disease Study.
3. Whooping cough fits are uncontrollable and intense.
“Whooping” cough is named for the sound of its victims, who gasp for breath after prolonged coughing fits.
"Parents will know. It is no mystery that something is wrong. Consecutive coughs don’t stop for 15 seconds up to a minute, and it can seem like a lot longer," explains Camille Sabella, MD, director of the center for pediatric infectious diseases at the Cleveland Clinic in Ohio. During coughing spells, a baby with whooping cough can have trouble catching their breath, turn red, not be able to get enough air, turn blue, and even stop breathing.
The infection starts off like a common cold, with a low-grade fever and cough in the first week. But coughing becomes so severe by the next week that it can cause you to vomit, turn blue, bruise or crack your ribs, and develop abdominal hernias and broken blood vessels, as the Mayo Clinic describes. Symptoms of pertussis vary in both duration and severity, notes Cameron Wolfe, MBBS, an infectious disease specialist at Duke University Hospital and Duke Medicine in Durham, North Carolina. “Very young infants often don't get the classic 'whoop' cough paroxysms that older children or adults can get. They sometimes just get severe breathlessness.”
4. Bacteria called Bordetella pertussis cause whooping cough, and new strains are circulating in the United States.
Once Bordetella pertussis bacteria get in the lungs, they stick to the lung's lining, where they make pertussis toxin. The toxin paralyzes the cilia, the tiny hairs lining the lung that usually move in waves to help the lungs clear away mucus through normal coughing. Whooping cough is anything but a normal cough; it is so severe that it interferes with breathing, eating, and sleeping.
Like other living things, bacteria adapt and change over time. Variations in the kinds of pertussis bacteria might be one of the reasons for the recent upsurge of U.S. whooping cough cases. A study of strains of bacteria from people who had whooping cough found that 85 percent were missing the bacterial protein that the vaccine targets, called pertactin. Half of the U.S. children who had whooping cough in recent years had already been vaccinated. During 2012 and 2013, data show that half of the children ages 6 month to 6 years who got whooping cough had already received three or more doses of the DTap vaccine, but got sick anyway.
5. There is a rising tide of U.S. whooping cough epidemics.
When U.S. childhood immunizations became routine, cases of whooping cough dropped dramatically — at first. For example, though 260,000 Americans had whooping cough in 1934, by 1976 there were only 1,000 U.S. cases, according to the CDC.
But over the past several years local outbreaks have increased, and statewide epidemics of whooping cough have been reported. One state alone, California, has experienced an ongoing whooping cough epidemic, with 10,831 cases reported in 2014. In 2015, outbreaks have been reported across the country. Many cases were in children, but about one-third of recent infections were in adolescents and one-fifth in adults. A close look at the pattern of increasing U.S. cases suggests that whooping cough vaccine effectiveness and duration of protection have changed, as reported in PLOS Computational Biology.
6. The young and ill are at higher risk for whooping cough.
Whooping cough doesn’t affect everyone in the same way. “It depends particularly on the strength of the patient's immune system, whether or not they have fully developed lungs, and whether they have a healthy immune system," says Dr. Wolfe. Pertussis is most dangerous for babies under age 1, who often need hospitalization when they're infected.
“It is mainly for the younger babies in the first six months of life before they are fully immunized that it’s especially critical,” adds Dr. Sabella. Most of the kids who need to be hospitalized for whooping cough are young children, he notes.
Not just the very young are vulnerable, however. “Anybody who has an immunocompromised condition is at higher risk,” Sabella explains. This includes those who have cancer, have had any kind of organ transplant, or live with chronic conditions like asthma or other lung problems.
7. The "cocoon effect" can help protect your baby from whooping cough.
To protect the most vulnerable, parents have to prevent a baby’s exposure to anyone who might have an infection, even a hidden one. “The cocoon effect is the best way to protect the newborn — everyone around them should be vaccinated: mom during pregnancy, parents, grandparents, siblings, and healthcare workers,” says Sabella.
If you are going to be around an infant, ask your doctor about getting a pertussis booster vaccine. Data on current levels of vaccine coverage shows a need for improvement. A survey of records from 2005 to 2013 found pertussis vaccination of adults at only 17 percent, and healthcare personnel at just 37 percent, according to the CDC’s Morbidity and Mortality Weekly Report for February 6, 2015.
RELATED: 10 Essential Facts About Measles
8. Vaccination is the best protection against whooping cough.
The pertussis vaccine is considered safe and is 80 percent to 90 percent effective at preventing infection. Side effects (including fever, headache, and fatigue) are typically mild.
The American Academy of Pediatrics (AAP) recommends a five-shot vaccination series called DTaP starting when a baby is 2 months old, with additional doses at 4 months, 6 months, 15 to 18 months, and 4 to 6 years. (DTaP is a combination vaccine that protects against tetanus and diphtheria infections as well as pertussis.)
About 83 percent of American kids aged 19 to 35 months have had the recommended four or more DTaP doses, reports the Immunization Services Division of the CDC. Vaccination rates of 80 to 95 percent should protect the community at large, due to the effect called "herd immunity."
9. Teens and adults need pertussis booster shots.
Teens and adults need a booster, because immunity from the childhood vaccine, DTaP, lasts for only about two years and then declines. "As we prove more adults get infected, we get a better sense of the imperfect nature of our adult vaccination coverage," explains Wolfe.
“Teenagers between 11 and 18 should get a single Tdap (a combined vaccine for tetanus, diphtheria, pertussis for teens and adults) once. Adults older than 18 should get a single Tdap vaccine if they haven't before," adds Wolfe.
10. Pregnant women need to get vaccinated against pertussis during every pregnancy.
It is especially critical that pregnant women get a Tdap booster, usually in the third trimester (between 27 and 36 weeks gestation) to extend protection to their newborn baby, recommends the AAP. After getting the vaccine, a pregnant woman transmits antibodies through the placenta to her developing fetus, offering about 90 percent protection from whooping cough infection in the first months of baby's life.
Current recommendations are for pregnant women to get the Tdap vaccination again in each pregnancy.
“There is evidence of waning immunity as time goes by,” explains Sabella.
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