Whooping Cough: It’s More than Just the ‘100-day Cough’

October 8, 2012
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By Dr. Teresa Liccardi


Dana McCaffery’s untimely death at 4 weeks old is immortalized on Facebook as Dana McCaffery—Whooping Cough Awareness. Tragically, this baby’s death and other infant deaths from whooping cough could have been prevented.

In 1975 the Japanese Ministry of Health halted the distribution of pertussis vaccines. For the three years preceding this decision there had been 400 documented cases of pertussis with 10 deaths. By 1978 – without the vaccine – there were 13,000 cases and 113 deaths due to pertussis infection.



What is whooping cough?


Whooping cough is a highly contagious respiratory infection caused by the bacteria Bortadella pertussis characterized by uncontrollable violent bouts of coughing that may last for weeks causing serious disease including death in infants. Transmitted person to person by droplets from coughing and sneezing, the bacteria invade the lining of the lung and excrete several toxins that inflame and damage lung tissue.

In the early phase, its symptoms are similar to the common cold with mild fever, congestion, runny nose and a mild cough. As the illness progresses, the coughing develops into prolonged fits that leave the person gasping for breath, whooping, vomiting and exhausted. A total of 57 percent of infants require hospitalization. Complications include pneumonia, convulsions, apnea (slowed or stopped breathing), encephalopathy (brain disease) and death. In adolescents and adults, common complications include weight loss, loss of bladder control, passing out, and rib fractures (from coughing). The cough may persist for longer than 10 weeks, which is why in China it has been deemed “the hundred-day cough.”



How common is pertussis?


Pertussis is endemic or very common in the United States. Because the pertussis vaccine does not confer lifetime protection, the incidence of pertussis has been rising as immunity wanes in adolescents and adults. Until the 1950s when the pertussis vaccine was introduced, there were more than 200,000 cases reported annually in the United States. Once the vaccine was available, the incidence of whooping cough dropped dramatically to under 5,000 cases per year.

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Since the 1980s the incidence has been gradually rising due to several factors including waning immunity. A total of 29,834 cases in the U.S. have been reported for the year 2012 through September. The greatest numbers of new cases of pertussis are occurring in children younger than 1-year-old and in those age 10. The incidence in 13 to 14 year olds is increasing as well. New Jersey has had three times as many cases this year compared to the same time last year. Highly contagious, pertussis spreads rapidly in institutional settings such as hospitals, schools and enclosed workspaces.


How is whooping cough treated?


Antibiotics may be used in the early stages to help reduce symptoms and reduce the period of infectivity, but prevention is the best medicine.


What is the best way to prevent whooping cough?


Getting vaccinated is the best prevention for infants, children and adults.

Maternal transfer of immunity during pregnancy protects infants less than 3 months of age. This is why pregnant women are advised to receive a pertussis vaccine in the third trimester of pregnancy. For children, full immunity requires a series of five vaccinations: Four in the first 12 to 18 months and a booster at 6 to 7 years of age. The vaccination does not confer lifelong immunity so a booster vaccine is recommended for children ages 10 to 14 and adults ages 19 to 65. Even after vaccination an individual can still contract pertussis. However, immunity from the vaccine reduces the severity and duration of symptoms. By immunizing adolescents and adults, infants are protected or “cocooned” from disease.

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What are the side effects of the vaccine?


Three serious diseases – diphtheria, tetanus and pertussis – ravaged our country until the middle of the 20th century. The vaccines DTaP and Tdap stimulate immunity for all three diseases. The original vaccine DTP was a “whole-cell” vaccine that had many severe side effects including high fevers, inconsolable crying for hours and seizures, as well as other local reactions such as redness, pain and swelling at the injection site. In 1996 a better purified “acellular” vaccine DTaP was marketed that had fewer and less severe reactions.

In 2005 the booster shot Tdap was released for adolescents and adults. Though the vaccines may have some side effects these are small compared to the seriousness of contracting whooping cough. Because infants are so vulnerable to serious disease from pertussis, it is imperative that all individuals in contact with infants have pertussis immunity. The Center for Disease Control website has detailed information on the different vaccines and safety at: www.cdc.gov/pertussis/vaccines.html .


Let’s protect our loved ones from this preventable disease. Learn more about pertussis at: www.cdc.gov/pertussis/ and ask your doctor about updating your vaccinations.


Dr. Teresa Liccardi, who is board certified in internal medicine and nephrology, maintains a clinic for hypertension and chronic kidney disease at the Parker Family Health Center in Red Bank.


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