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Ask Dr. Sue
PERTUSSIS (WHOOPING COUGH)
Dear Dr. Sue,
I have heard that there is an increasing number of
outbreaks of pertussis in the state. I have a four
week old baby at home and a son in first grade.
Are they at risk? How serious is this, and what
should I be watching for?
Mom
Dear Mom,
Anyone who is exposed to pertussis can get it, even
those who have been vaccinated against it. Those who
haven't completed their series of five immunizations,
and especially those who were never vaccinated at all,
are likely to get much sicker from the disease.
Children under six months of age who contract this
illness are in the greatest danger of severe
complications and a bad outcome.
Pertussis is a bacterial lung infection that is
extremely contagious. Symptoms usually start six
to twenty-one days after exposure, and the symptoms
usually just look like a typical cold during this first
stage. Sometime during the first two weeks,
however, a severe cough develops which can last from one
to two months. In classical cases, the cough comes
in long paroxysms, which consist of five to fifteen
harsh coughs, often with a "whoop" as the child breathes
in. This will be followed by a few normal breaths,
and then the paroxysms will start again. At first,
the paroxysms happen mainly at night, but as time goes
on they become more and more frequent during the day.
During these spells, the lips and nails (or even the
entire face) may turn blue due to lack of oxygen.
There may also be very thick secretions that contribute
to the breathing difficulty, and may cause vomiting and
therefore aspiration into the lungs.
As mentioned above, immunized older children and adults
often have a milder illness without the classical
symptoms. Infants under six months of age more
often will have breath-holding spells, cyanosis (that
blue color just described), and vomiting, and may not
have the easily recognizable paroxysms. They have
the greatest risk of secondary pneumonia, seizures (with
or without bleeding inside the brain), brain damage, and
even death (although the last two are uncommon with
access to good medical care).
Hopefully your older child is immunized against this
disease. If he is not, you may want to consider
giving him getting started, though he can't have any
DTaP vaccine after the age of seven. Your baby has not
had his first dose yet, since the series is usually
begun at the two month visit. DTaP can be given to
babies as young as six weeks of age, so you may want to
consider having that visit early, since you can't
control the exposures of your older child. You do
have control over the places you take your baby, though,
so you may want to examine your options there.
Places like daycares and church nurseries are great
places for infection to spread, so you might want to
avoid them for now, if possible. Malls, parks and
other places where there is less close contact and
better ventilation would be lower risk. Stay away
from people with obvious respiratory symptoms (remember,
pertussis looks like a regular cold during the time when
it is most infectious).
If, in spite of your care, one of your children develops
a cold with a severe cough, especially one that causes
vomiting or comes in long spells that cause them to turn
red (or blue!) in the face, visit your pediatrician.
There are many other respiratory illnesses out there
right now, and pertussis certainly would not be the most
likely one on the list, but pediatricians are keeping it
in mind even more than usual due to the outbreaks in the
state.
If your children are exposed to a person who is later
proven to have pertussis, they should be treated
preventatively with erythromycin or azithromycin.
More information about pertussis:
-
When someone who has pertussis
received antibiotics, they reduce how infectious
that person is; they do not make the illness less
severe or shorter. Since the disease can be
quite dangerous to young infants, it is important to
reduce the number of people who are infectious in
the community, though - to keep it from being
brought home to the youngest community members.
-
An infected person will no longer be
contagious after five days of THE PROPER antibiotic.
Pertussis must be treated with erythromycin, or one
of erthrymycin's newer cousins. For the rare
person who is truly allergic to erythromycin, a
sulfa antibiotic is advised, but there is limited
knowledge about its effectiveness.
-
Pertussis is not really rare in
adults with persistent coughs, since the protection
from the vaccine only lasts from five to ten years
after the last dose.
-
The risk of an unimmunized child in
daycare or elementary school catching pertussis is
sixteen times more likely than a child who is
immunized, according to one study.
-
In the same study, schools with
pertussis outbreaks had three times more students
who had been exempted from immunizations than
schools with no outbreak. This means that
there is greater community risk when there are more
unimmunized children.
-
If your child is not immunized and
there is a pertussis outbreak in his/her school,
your child may be required to leave school and not
return until one incubation period (21 days) after
the last case, which could be a total of several
weeks during a large outbreak.
Webmaster's Note: A new adolescent
vaccine has been approved and released since the writing
of this article. The Tdap vaccine combines the tetanus
booster that children normally get at age 11-12 and
every 5-10 years thereafter with a vaccine component
that boosts immunity to pertussis. Now those older
than 7 years can be immunized against pertussis too!
 
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