A Potentially Deadly Disease That Can Be Easily Prevented

Pertussis, or ‘Whooping Cough'

As parents, we do everything we can to keep our kids safe. We cuddle them and hold them, love them and keep them warm. But those very actions can be dangerous, even deadly, if we carry pertussis.

“We can’t control everything that could happen to our children, but pertussis is one disease where we have options,” said Dr. Nancy Van Vessem, chief medical officer at Capital Health Plan.

More commonly known as whooping cough, the
highly contagious respiratory disease is caused by a type of bacteria called bordetella pertussis. According to the

U.S. Centers for Disease Control, the bacteria cling to the tiny cilia — hair-like branches — that line the upper respiratory system. Then the bacteria release germs that harm the cilia and cause swelling or inflammation.

Pertussis is only found in humans and, according to the CDC, symptoms usually develop seven to 10 days after exposure but they can take up to six weeks to present. It can be a difficult infection to spot and reveals itself in three states:

Stage 1: The disease starts out like the common cold. It can show with a mild fever, runny nose and slight cough. This stage lasts for one to two weeks.

Stage 2: It brings about violent coughing fits that can make breathing tough. In fact, it’s the labored breathing or whooping that gives pertussis its nickname. (Think wheezing, phlegmy, smoker-with-emphysema kind of cough.) The coughing may also bring about vomiting and exhaustion and can cause blood vessels around the eyes to break. This stage typically lasts for one to six weeks, although it can last up to 10 weeks.

Stage 3: The infected person finally starts to rebound, but bouts of coughing and secondary infections are still possible.

Since the 1980s, the CDC says there’s been an increase in the number of cases in the U.S., especially among 10-19 year olds and infants younger than 6 months old. Some blame the increase on a recent reluctance to vaccinate, but the CDC says the U.S. actually sees periodic epidemics of pertussis every three to five years. The last peak was in 2005 when more than 25,000 cases were reported; 2009 saw nearly 17,000 cases.

A vaccine is available, but for those who do come down with the disease, it can seem to last for an eternity.

“The bacteria attach to the lining of the airway, causing significant changes which persist even after the infection has cleared,” Van Vessem said. “These changes cause the prolonged cough. In China it is referred to as the 100-day cough.”

 

Who Gets It

Pertussis knows no bounds and thus is present around the globe. The CDC said it is especially prevalent in developing areas where fewer people are vaccinated and the medical care available to them is sometimes inferior and often harder to come by. For these reasons, millions are infected with pertussis each year, and hundreds of thousands of people lose their lives to the disease.

Yet despite modern medicine and advancements in care, pertussis is not strictly a Third World disease.

“We are seeing scattered outbreaks across the country,” Van Vessem said.

In fact, many areas of the United States have seen outbreaks of pertussis over the past few years, with the West Coast being hit especially hard. According to the California Department of Public Health, more than 6,000 cases were reported in 2010 alone — the largest number reported in 60 years.

In Florida, 314 probable or confirmed cases of pertussis were reported in 2008, the most recent year for which statistics were available from the state Department of Health’s Office of Health Statistics and Assessment. This represents a 33-percent increase over the number of cases reported in 2007 and a 61-percent increase over 2006.

From 1999 to 2008, Florida records show a total of four deaths related to pertussis: one in 2005, one in 2006 and two 

in 2008. Worldwide, the World Health Organization reported an estimated 195,000 deaths due to pertussis in 2008.

Of those infected with the disease, Van Vessem said the youngest are the most susceptible because of their smaller sizes and the fact that their immune systems are not as developed.

“Babies and small children have small airways leading to their lungs,” she said. “Pertussis causes swelling in those airways, so it is relatively more severe in small people as compared with larger people.”

The CDC said that more than one-half of infants under the age of 1 who get the disease are hospitalized for it. The younger the infant, the more likely he or she will need hospital care. Of those infants who are hospitalized with pertussis, half will have trouble breathing, 1 in 5 will contract pneumonia, and 1 in 100 will die.

The National Institutes of Health also said the whooping sound that signals the disease in many children and teens is often absent in babies ages 6 months and under and adults, which can make diagnosing it in those groups even more difficult.

 

How It’s Spread

Pertussis is highly contagious and can spread easily from person to person. On the CDC’s “Kid Friendly Fact Sheet,” the “Pertussis Disease Villain” is known as an “air attacker” because it moves through the air until it reaches a person to cling to and infect.

The disease is transferred when a person coughs or sneezes, but the bacteria don’t always have to be passed from person to person directly. The CDC said it can also be passed to someone via a contaminated surface or object — for example, when an infected child coughs or sneezes on a toy, then passes that toy to a friend who plays with it and touches his or her face, or puts that toy directly into his or her mouth.

Surprisingly, parents, older siblings, family members and caregivers are the most likely to pass the whooping cough infection on to the little ones because many teens and adults are not properly immunized against it.

It has been more than 100 years since scientists first identified the bordetella pertussis bacteria in 1906. By the late 1940s, the pertussis vaccine was given regularly. Van Vessem said the vaccine used to contain whole cells of the inactive pertussis bacteria, but those were found to have certain unfavorable reactions, such as erythema — a reddening of the skin — as well as swelling and pain at the site where the shot was given.

“Now, the acellular vaccine is widely available,” Van Vessem said. These vaccines, which do not contain the infected cells, are shown to have fewer adverse side effects.

 

Prevention

For infants as young as 2 months, the CDC recommends the DTaP vaccine; this combo shot protects against diphtheria, tetanus and pertussis. “The first three shots are given at two, four and six months of age,” the CDC writes. “The fourth is given between 15 and 18 months of age, and the fifth shot is given before a child enters school at four to six years of age.”

However, Van Vessem said immunizations received as a baby do not give extended protection, so a booster shot is recommended for adolescents and adults. That booster is called the TDaP and can be given instead of the traditional Td booster. It is recommended for any teen or adult up to age 65.

“In non-immune households, the attack rate is 80 to 90 percent,” Van Vessem said. All children are required to be up-to-date on their vaccinations before starting school.  However, Ann Waltz, the immunization nurse for the Leon County Health Department, said those who oppose them for religious reasons can be exempt if a parent and health department administrator sign a religious exempt form. Still, Van Vessem said it only takes one outbreak close to home to send people running to get immunized. 

“When I was an internal medicine resident years ago, there was a pertussis outbreak in Wyoming,” she said. “This happened primarily in communities where people had decided not to have their children vaccinated. It just takes seeing one child struggle for air or a child’s death reported in the newspaper to change attitudes overnight.

“The demand for pertussis vaccine was so great in Wyoming that they borrowed vaccine from all the neighboring states,” Van Vessem said. “The previously reluctant parents were desperate to get their children vaccinated when they became fully aware of the risks from the disease. I did not hesitate to have my children immunized.”

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