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Whooping Cough Makes a Comeback If you go to a web site calledwww.whoopingcough.net you can listen to the awful, inhalational whine that is characteristic of whooping cough. It doesn’t sound anything likewhooping cranes. It sounds like a small pair of lungs struggling for air. Once upon a time, itwas a tragically familiar sound in the United States. Once upon a time, there were roughly200,000 annual cases of whooping cough in the United States. Today, that number is in thethousands, but the possibility of catching this preventable infection remains.Whooping cough, or pertussis, is a highly contagious bacterial infection caused by
 Bordetella pertussis
.Pertussis infections begin in two stages. The bacteria first colonize the respiratory tractand begin to produce fever, coughing and malaise in the human host. Then the bacteria begin to pump out a variety of toxins. Severe coughing and cyanosis begins. One of these toxins, thePertussis Toxin (PT) inhibits some immune functions and kills host cells. PT is largelyresponsible for whooping cough deaths and the ability of the bacteria to re-infect people.After 
 Bordetella pertussis
was isolated a century ago, work began on a vaccine againstthis sometimes fatal infection. In 1948, a vaccine was licensed in the U.S. Its widespread useled to a dramatic decline in the number of pertussis cases. The low point was 1976 when justover a thousand cases were reported. Since then pertussis cases have been increasing steadily.During the 1980-1990 period, for example, the annual number of reported cases averaged 2,900.Why the increase?Part of the reason may have been the vaccine. The original vaccine was a crudeconcoction of killed bacterial cells, which was given in combination with vaccines for diphtheria1
 
and tetanus (the DPT shot). Sometimes there were unpleasant side effects from the pertussisvaccine, and in rare cases, seizures occurred in young children. With the overall risk of pertussisdeclining after decades of childhood vaccinations, the risk of adverse events from the vaccine began to look less and less acceptable to many people. Some parents stopped having their children vaccinated, and public rejection of the vaccine added to the jump in annual cases of  pertussis.Someone needed to build a better vaccine. In 1996 a new “acellular” pertussis vaccinewas licensed. This vaccine consists largely of inactivated pertussis toxin instead of whole bacterial cells. It has none of the serious side effects of the old vaccine. It too is given withdiphtheria and tetanus vaccines, and that trivalent mix is designated, DTaP.But the new vaccine did not put an end to pertussis. High numbers of cases were still being reported. In 2005, the Centers for Disease Control and Prevention (CDC) recorded 21,003cases. (Maryland had 199.) That was up from 9,784 in 2003 and 18,957 cases in 2004. Clearly,something else is going on with pertussis and vaccination.That something is waning immunity. After ten years or so the protective immunity provided by the whooping cough vaccine begins to fade away and people again becomesusceptible to infection. This may be why sixty percent of newly diagnosed cases now are foundamong teens and adults.Among adults, one clue to suggest a lack of immunity may be the appearance of arelentless cough. Persistent, painful coughing from unrecognized pertussis can lead to pneumonia and hospitalization. It can also lead to fractured ribs in some cases. All thatcoughing is also spraying
 B. pertussis
into the air and creating opportunities for infecting other  people. Once the cough is recognized as pertussis antibiotics are used to treat the infection and2
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