Pertussis, an infectious disease that dates back to the 16th century, when the first known outbreaks were described, is back in the news again. Commonly referred to as ’whooping cough,’ pertussis can afflict people of all ages, but it is most serious for very young infants under six months of age.
The bad news is that, according to the Centers for Disease Control and Prevention (CDC), some 18,000 cases of pertussis have been reported this year. That’s twice the number compared to last year at this time. If the pace continues, the final count could be the highest since 1959, when about 40,000 cases were reported, as compared to the lowest number, 1,010, reported in 1976.
The good news is that pertussis, which results in the inflammation of the upper and lower airways, is preventable. The bacterium called bordatella pertussis, which causes whooping cough, was discovered in 1906, but it wasn’t until the 1940s that an effective vaccine was introduced. Yet, despite the wide accessibility of the vaccine today, we are seeing an increase in pertussis, one reason being that some parents refuse to vaccinate their kids.
According to the CDC, by early July this year, 37 states had reported increases in whooping cough compared with the same time period in 2011. In Massachusetts, the number of cases are on the increase after declining since 2007, when 1,188 cases were reported, compared with 273 last year. This year, however, the Mass. Department of Public Health (DPH) reports that there have been twice as many confirmed cases of pertussis as in the same time frame in 2011. Over the past few years, there has also been a slight increase in the number of cases of whooping cough among the 7-10 age group. Other groups that may be seeing an increase in Massachusetts are infants and teens ranging in age from 11-19.
While we are not yet seeing an epidemic in Massachusetts, the increase in numbers statewide is a concern, especially for infectious-disease specialists, because we know this illness can take its worst toll on our youngest babies, and can cause prolonged illness and symptoms in teens and adults. We may also begin to see increases in hospitalizations if there is more spread of whooping cough to unimmunized infants. And, if school-aged children become ill with whooping cough and spread it to others in the classroom, there may be increases in school absences in communities where there is increased circulation of pertussis.
Pertussis often begins like a simple cold, with a runny nose and congestion. The illness has three phases; however, not everyone will exhibit the symptoms of all three phases. During the second phase, about one week into the ’cold,’ it can cause a person to have a severe, prolonged cough, especially for infants and children who have never had the infection. Adults with pertussis can also suffer from a prolonged coughing period.
A child’s cough can be described as short, occurring as spasms that can cause shortness of breath, or breath-holding for babies. In some children, there is a sound described as a ’whoop’ at the end of their coughing spasm, as if gasping for air. Many people cough until they are literally ’blue in the face,’ and may vomit afterward from the force of the cough.
During the third stage, the cough is less intense and less frequent. Eventually, the cough stops, although it may take several months. Any baby exhibiting these symptoms should be evaluated by a doctor. Adults who have a cough along with the described symptoms lasting for over two weeks should consider consulting with their doctor, especially if they are around young children to whom they could transmit the disease.
Most children, teens, and adults will recover from pertussis without treatment, but may continue to spread the infection to others during the initial cold phase and for the first two weeks of coughing. Several antibiotics can shorten the illness and prevent the bacteria from being spread by cough droplets. Treatment must be given early in the illness in order to reduce the length of cough. Also, if there is a suspicion that your baby might have whooping cough, it is highly recommended that you have him or her tested as soon as possible. The illness can cause severe feeding issues in an infant; severe breathing difficulties, including holding their breath; seizures; and, in the worst-case scenario, even death in babies, which is rare. In older children and adults, the coughing spasms can be severe enough to cause broken ribs. However, once a person recovers from whooping cough, there are usually no residual effects.
So, how can you protect your child, yourself, your loved ones, and others around you, and help to prevent any future epidemics of pertussis? The answer is simple — get vaccinated.
Protection begins with children, and the American Academy of Pediatrics and the Advisory Committee on Immunization Practices (ACIP) recommend the pertussis vaccine be given to all infants beginning at 2 months of age. The schedule is generally three doses given in the first six months of life, and then a dose at 15-18 months of age. A school entry dose at 4-6 years of age should also be given. Also, a booster dose should be given at 10-11 years of age. These immunizations are required for day-care, preschool, and school entry in Massachusetts.
Of increasing concern, some parents are considering waiting or, even worse, not vaccinating their children for many reasons. Pediatricians are trained to be experts in immunizations and can have meaningful discussions with parents about the benefits of vaccination to protect their families.
Another reason for the increase in reported pertussis cases is the few number of teens and adults who have received the recommended booster shot for whooping cough. It is very safe to give the pertussis vaccine to adults. It has recently been recommended by ACIP and the American Congress of Obstetricians and Gynecologists (ACOG) to give pregnant women the pertussis vaccine in the late second trimester and third trimester of pregnancy. The vaccine will help to protect a mother-to-be from becoming sick with whooping cough and also create antibodies that they can pass along to the baby before they are born.
A newer strategy of immunizing all family members when a baby is born, including new fathers and grandparents, is one way of protecting the newborn, known as ’cocooning’ the infant. Even adults over the age of 65 should have a dose of the vaccine, especially if they are planning to be around infants, including their grandchildren and others. Health care providers of women of childbearing age and obstetricians can and should be sharing this important information with women, as well as providing the vaccine. v
Dr. Donna Fisher is interim chief of Pediatric Infectious Diseases at Baystate Children’s Hospital.