The 3 year old girl sat quietly on the exam table as her mom described her symptoms. “A couple of weeks ago she had what just seemed like a cold. Then she developed a little cough. But day by day it’s just gotten worse and worse. She’ll seem fine in between coughing spells but when she starts coughing she just goes and goes until she finally has to take a big breath in. Sometimes she coughs so hard it makes her throw up. And night-time is terrible; that’s when it really picks up.”
That description is quite typical for whooping cough, also called pertussis, and sure enough the nasal swab we used to test this little one came back the next day positive for pertussis. Whooping cough gets its name from the “whooping” sound that is made when gasping for air after a fit of coughing. It is sometimes called “the 100 day cough” but it often drags on even longer. Worldwide there are still an estimated 30-50 million cases of whooping cough yearly with about 300,000 deaths. Pertussis is particularly prevalent in the many nations where vaccination rates are low. One study found that, in eight countries where immunization coverage was reduced, incidence rates of pertussis surged to 10 to 100 times the rates in countries where vaccination rates were sustained.
In the U.S., before pertussis immunizations were available, nearly all children developed whooping cough. Between 150,000 and 260,000 cases of pertussis were reported each year, with up to 9,000 pertussis-related deaths. Since the onset of routine vaccination, pertussis has fallen to about a 10th of that number of cases and last year, for comparison, there were 18 deaths from pertussis. Case numbers show that children who haven’t received pertussis vaccine are at least 8 times more likely to get pertussis than children who received all 5 recommended doses.
The majority of deaths occur among infants younger than 3 months of age and more than half of infants less than 1 year of age who get pertussis are hospitalized. That’s why, besides the need to start vaccination of infants promptly at 2 months of age, vaccination of preteens, teens and adults – including pregnant women – is especially important for families with new infants. Unfortunately, this little 3 year old is from a big family who doesn’t immunize, and the disease is quite infectious.
Here’s the tricky thing about whooping cough: It starts just like a cold, followed a few days later by an increasing cough. So at first, it really doesn’t seem like anything very serious. By the time the cough has really shown itself to be something suggesting whooping cough, antibiotics (such as azithromycin and other relatives of erythromycin) only slightly change the course of the illness. Antibiotics do at least render the person non-infectious which is no small thing given how highly contagious it is.
So, what are the take-home messages? Old, and potentially deadly, illnesses like whooping cough are still around and can rear their ugly heads, especially when vaccination rates fall. So be sure and protect yourself, your kids, and your community with timely immunization. When whooping cough is around, there is no need to panic, but there is certainly a need to be vigilant. Even minor respiratory symptoms need to be checked out early to stop the progress of this miserable, and potentially dangerous, malady.
Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. He is contracted with some commercial insurance carriers and sees Direct Primary Care patients who do not have insurance, who belong to a cost sharing ministry, or who are on Medicare. He is accepting new patients. You may contact him at 982-0835.