Whooping Cough

Definition
Whooping cough — known medically as pertussis — is a highly contagious
respiratory tract infection. Although it initially resembles an ordinary cold, whooping
cough may eventually turn more serious, particularly in infants. In the more advanced
stages, it's marked by a severe, hacking cough followed by a high-pitched intake of
breath that sounds like "whoop."

The incidence of whooping cough has been increasing, primarily among children too
young to have completed the full course of vaccinations and teenagers whose
immunity has faded.

With proper care, most teenagers and adults recover from whooping cough without
complications. Whooping cough is more serious in children, especially infants
younger than 6 months of age.

Symptoms
Early signs and symptoms
Once you become infected with the bacterium that causes whooping cough, it takes
about three to 12 days for signs and symptoms to appear. They're usually mild at first
and resemble those of a common cold, such as:

 A runny nose
 Nasal congestion
 Sneezing
 Red, watery eyes
 A mild fever
 Dry cough
 General feeling of being unwell and loss of appetite

Later stage signs and symptoms

After a week or two, signs and symptoms become worse and usually include:

 Severe coughing attacks that bring up thick phlegm

 Coughing attacks — up to 15 coughs in a row — that end with a high-pitched
"whoop" sound during the next breath of air
 In children, severe coughing that leads to vomiting or causes a red or blue face
from the effort
 Fatigue from the exertion of coughing

Coughing characteristics
In adults, signs and symptoms of whooping cough may resemble those of bronchitis, a
respiratory infection that causes a nagging cough. Babies and infants with whooping
cough may not whoop at all, or at least not as loudly as older children do. Some
children with whooping cough may experience choking spells and turn blue in the
face as they struggle to breathe after extended coughing.

Severe coughing can result in tiny red spots caused by ruptures in blood vessels at the
skin's surface (petechiae) in the upper body, as well as small areas of bleeding in the
whites of the eyes. You may even bruise or break a rib if your coughing episodes are
severe. Coughing may be worse at night.

Causes

Whooping cough is a respiratory infection affecting mostly the windpipe (trachea)

and the tubes branching off from the windpipe (bronchi). It's caused by the Bordetella
pertussis bacterium, which is transmitted through droplets that are coughed or sneezed
into the air by someone who's already infected. Whooping cough is most contagious
early on, but the possibility of spreading the illness remains until the infection clears
completely.

Once inside your airways, the bacteria multiply and produce toxins that interfere with
your respiratory tract's ability to sweep away germs. Thick mucus accumulates inside
your airways, causing uncontrollable coughing.

The bacteria also cause inflammation that narrows breathing tubes in your lungs. This
narrowing leaves you gasping for air — sucking in air with a high-pitched "whoop"
— after a fit of coughing.

Risk factors
Some people think of whooping cough as having gone the way of polio — a
childhood disease eradicated thanks to a vaccination campaign. But whooping cough
hasn't been wiped out. In fact, the number of reported cases in the United States has
been increasing since a historic low of approximately 1,000 cases in 1976. In 2004,
more than 25,000 cases were reported, the largest number since the 1950s, according
to the American Academy of Pediatrics.

Whooping cough is thought to be on the rise for two reasons. The whooping cough
vaccine you receive as a child eventually wears off, leaving most teenagers and adults
susceptible to the infection during an outbreak — and there continue to be regular
outbreaks. In addition, children aren't fully immune to whooping cough until they've
received at least three shots, leaving those 6 months and younger at greatest risk of
getting the infection.

When to seek medical advice

Call your doctor immediately if you experience prolonged, severe coughing spells,
especially if these spells make you turn red or blue, are followed by vomiting or occur
together with a whooping sound when inhaling. Call your child's doctor if your child
experiences any of the same symptoms.

In addition, call your doctor if you or your child has been exposed to someone with
whooping cough, even if you've been vaccinated. You or your child may need
treatment with antibiotics or perhaps a booster of whooping cough vaccine to prevent
infection.

Tests and diagnosis

Diagnosing whooping cough in its early stages can be difficult. That's because the
signs and symptoms resemble those of other common respiratory illnesses, such as a
cold, the flu or bronchitis.

Sometimes, doctors diagnose whooping cough simply by asking about symptoms and
listening to the cough. Medical tests may be needed to confirm the diagnosis. Such
tests may include:

 A nose or throat culture and test. Your doctor takes a nose or throat swab or
suction sample. The sample is then sent to a lab and tested for whooping
cough bacteria.
 Blood tests. A blood sample may be drawn and sent to a lab to check for a
high white blood cell count. White blood cells help the body fight infections,
such as whooping cough. A high white cell count typically indicates the
presence of infection or inflammation. This is a general test and not specific
for whooping cough, however.
 A chest X-ray. Your doctor may order an X-ray to check for the presence of
fluid in your lungs, which can occur when pneumonia complicates whooping
cough and other respiratory infections.
If whooping cough is the diagnosis, your doctor will advise you to avoid contact with
others during recovery because the condition is highly contagious. Don't return to
work until your doctor approves. For the same reason, don't take your child with
whooping cough to school or child care until your child's doctor gives the OK. In
general, children should stay out of school while they are taking antibiotics for
pertussis.

Your doctor will also notify health authorities who keep track of whooping cough
outbreaks.

Complications
Teenagers and adults
Teenagers and adults usually recover from whooping cough with no complications.

If complications occur, at worst, they include coughing that may lead to:

 A bruised or broken rib

 Hernia — an abnormal protrusion of a loop of intestine through a weak area of
abdominal muscle

Children
Children with whooping cough also may:

 Injure the muscles of the chest wall

 Develop a hernia

Infants
In infants — especially those under 6 months of age — complications from whooping
cough are more severe and may include:

 Ear infections
 Pneumonia
 Slowed or stopped breathing
 Dehydration
 Seizures
 Brain damage

Because infants and toddlers are at greatest risk of complications from whooping
cough, they're more likely to need treatment in a hospital. In infants under 6 months
of age, complications can be life-threatening.

Treatments and drugs

Treatment for whooping cough varies, depending on your age and the severity of
signs and symptoms.

Older children, teens and adults

When whooping cough is diagnosed early in older children, teenagers and adults,
doctors usually prescribe bed rest along with an antibiotic such as azithromycin or
erythromycin. Although antibiotics won't cure whooping cough, they can shorten the
duration of the illness and they shorten the period of communicability. If there is a
confirmed diagnosis but a slow response to antibiotic therapy, it may be necessary to
take the antibiotic for at least two weeks or longer.

If the illness has progressed to the point of severe coughing spells, antibiotics aren't as
effective but may still be used. Unfortunately, not much is available in the way of
symptom relief. Over-the-counter cough medicines, for instance, have little effect on
whooping cough. A case of whooping cough usually resolves in six weeks but may
last longer.

Infants and toddlers

Almost all infants with whooping cough who are younger than 3 months, as well as
many older babies, are admitted to the hospital to decrease the risk of serious
complications. Most babies treated for whooping cough overcome the condition
without lasting effects, but the risk of complications exists until the infection clears.

In the hospital, your child is likely to receive intravenous antibiotics to treat the
infection and perhaps corticosteroid drugs, which help reduce airway inflammation.
Sometimes a child's airway may also be suctioned to remove mucus that's blocking it.
Your child's breathing will be carefully monitored in case extra oxygen is needed.

If your child can't keep down liquids or food, intravenous fluids may be necessary. In
some cases, prescription sedatives will help your child rest. Your child will also be
isolated from others to prevent the infection from spreading.

Prevention
Childhood vaccine — DTaP
The best way to prevent whooping cough is with the pertussis vaccine, which doctors
often give in combination with vaccines against two other serious diseases, diphtheria
and tetanus. This three-in-one combination is known as the DTaP vaccine. It's a newer
and safer version of the DTP vaccine, which is no longer used in the United States.

Doctors recommend beginning DTaP vaccination during infancy. The vaccine

consists of a series of five shots, typically given in the arm to children at these ages:

 2 months
 4 months
 6 months
 12 to 18 months
 4 to 6 years

It takes at least three shots of the pertussis vaccine to fully protect a child against
whooping cough, but a total of five shots are recommended by age 6 years.

Adolescent booster vaccine — Tdap

Because immunity from the pertussis vaccine tends to wane by age 11, and because of
the increase in cases of whooping cough in adolescents and teens between 11 and 18
years of age, doctors recommend a booster shot for those in this age group. This is the
tetanus, diphtheria and pertussis vaccine, or Tdap. (DTaP is the name of the pediatric
vaccine and Tdap is the name of the booster for people 11 years of age and older.)
The booster is given preferably at ages 11 or 12. This is in place of the traditional
tetanus and diphtheria (Td) vaccine received at this age.

Adult booster vaccine — Tdap

The Centers for Disease Control and Prevention's Advisory Committee on
Immunization Practices also advises adults to receive an initial Tdap or booster shot
every 10 years instead of the Td booster shot. The Tdap vaccine helps protect adults
from pertussis and reduces the risk of them transmitting the infection to infants.
Adults who are or will be in close contact with infants under 12 months of age should
also receive the vaccine.

Vaccine side effects

Side effects of the vaccine may include fever, irritability, vomiting or soreness at the
injection site. These problems are more likely to occur after the fourth or fifth dose of
the DTaP series than after earlier doses. After later doses, some children may develop
swelling of the arm or leg in which the shot was given. Ask your doctor what you can
do for your child to minimize or relieve these side effects.

In rare cases, severe side effects may include:

 Serious allergic reactions, in which hives or a rash develops within minutes of

the injection
 High fever of greater than 105 F (41 C)
 Seizures, shock or coma

Some people are concerned that the pertussis vaccine may cause neurological
impairment because some children have developed brain damage near the time that
they received the immunizations. So far, however, researchers have not found a
definitive link between the pertussis vaccine and brain damage. Still, research into this
issue is ongoing. Children with known seizure or brain disorders may not be
candidates for the DTaP vaccine.

Alternative vaccines
There is another combination pertussis vaccine. In addition to helping protect against
pertussis, diphtheria and tetanus, the vaccine, Pediarix, also immunizes children
against polio and hepatitis B, a serious liver infection. Because Pediarix protects
against five diseases, children need fewer shots. But the vaccine also causes a wider
range of side effects than does DTaP. Talk to your pediatrician about the best choice
for your child.

Antibiotics
If a member of your household develops whooping cough, your doctor will likely
prescribe antibiotics for the whole family to prevent spread of the infection to anyone
else. And if you've had close contact with someone infected with whooping cough
outside your family, you also may need to receive antibiotic treatment.
Lifestyle and home remedies
The following tips on dealing with coughing spells apply to anyone being treated for
whooping cough at home:

 Get plenty of rest. A cool, quiet and dark bedroom may help you relax and
rest better.
 Drink plenty of fluids. Water, juice and soups are good choices. In children,
especially, watch for signs of dehydration, such as dry lips, crying without
tears and infrequent urination.
 Eat smaller meals. To avoid vomiting after coughing, eat smaller, more
frequent meals rather than large ones.
 Vaporize the room. Use a mist vaporizer to help soothe irritated lungs and to
help loosen respiratory secretions. If you use a vaporizer, follow directions for
keeping it clean. If you don't have a vaporizer, a warm shower or bath also can
temporarily help clear the lungs and ease breathing.
 Clean the air. Keep your home free of irritants that can trigger coughing
spells, such as tobacco smoke and fumes from fireplaces.
 Prevent transmission. Cover your cough and wash your hands often. If you
must be around others wear a mask.

Coping and support

Whooping cough isn't necessarily something that can be overcome in a week or two.
This bacterial infection may persist for six weeks or longer. That means you may need
to be off work for an extended period while you recover from whooping cough
yourself or attend to a sick child.

Be familiar with your company's sick-leave policy or short-term leave for such family
health emergencies. As a parent, you may want to prepare a list of in-home child care
providers whom you can call when your child has to be at home and you can't be there
yourself.