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Ask Dr. Sue
PROTECT YOURSELF AND YOUR BABY FROM
WHOOPING COUGH
Dear Dr. Sue,
I’m pregnant and I’ve been reading about whooping cough
and young babies. I do plan to have my baby get
the normal shots, but I heard that adults can get the
whooping cough shot, too. Should I ask for one?
Dear Mom,
You are very wise to be concerned about whooping cough (pertussis).
Before the development of a vaccine for this disease,
this infection used to kill thousands of babies in the
U.S. each year. A vaccine became available in the
mid-1940s, and U.S cases of pertussis had declined 99%
by 1970, and to its lowest ever by 1976 (slightly more
than a thousand cases). However, since then there
has been a gradual increase in pertussis cases, with
more than 25,000 cases being reported in 2005. Some of
the increase may be due to more frequent recognition of
the disease when it is present, but keep in mind that
some researchers say only 12% of cases are diagnosed and
reported even now. (1)
Pertussis is extremely contagious. It is spread by
respiratory droplets, which are expelled when an
infected person coughs, sneezes, or even talks. It
starts out looking like just another cold, with runny
nose, a relatively mild cough and perhaps a mild fever.
However, about two weeks later, instead of improvement,
there is a significant worsening of the cough. The
cough then begins to occur in long, drawn out spasms, or
paroxysms. Young babies are most likely to
demonstrate an actual “whoop,” which is the noisy gasp
for air that occurs midway through a coughing fit. (On
the website
www.pertussis.com you can actually hear what
pertussis in an infant sounds like.) Older
children may instead cough to the point of vomiting.
At any age the prolonged spells of coughing can be
exhausting and can cause weight loss and/or dehydration
as the sick child loses interest in food and drink.
Although whooping cough is no picnic at any age, young
infants are the most at risk from this disease. In
addition to dehydration and weight loss, infants can
develop seizures, swelling of the brain, or pneumonia as
complications of pertussis. Prolonged coughing
spells can deprive them of adequate oxygen. Death
can occur in infants, as well. In 2004, there were
24 deaths from pertussis in babies under three months of
age (and only 3 in children older than three months).
In 2005 there were 32 deaths in young infants (and 7 in
those older than three months). (2)
Adolescents and adults with pertussis generally miss
school or work. They can develop pneumonia or can
crack a rib from coughing, even without a complicating
bacterial infection. They can be sick for two or
three weeks, or their illness may linger for three or
four months (the Chinese call whooping cough the
“hundred day cough.”)
Adolescents and adults are the primary source of
infection for young babies, because the immunity
obtained from the preschool series of pertussis
vaccinations only lasts for about six years. Even
the immunity acquired from the natural infection wanes
after about six years. Once someone is diagnosed
with pertussis they are asked to avoid contact with
other people and ESPECIALLY with young infants, but a
diagnosis of pertussis isn’t even considered until
symptoms begin getting worse instead of better, at about
two weeks into the illness. The infection is most
contagious in the entire first two to three weeks.
It is wise to keep people with mild cold symptoms away
from your young infant even if a cold is all you think
they have. But what if the person with mild cold
symptoms is you…or their father…or their siblings?
(Studies have suggested that mothers are responsible for
nearly 1/3 of pertussis cases in their babies.)
To protect vulnerable young infants, as well as to
protect adolescents and adults from a fairly miserable
illness, the new Tdap vaccination is available and
recommended. All adolescents should get this
booster instead of a plain tetanus booster at around the
time of their 11 year old well child exam. This
will eventually take care of the dilemma of what to do
with unvaccinated pregnant women. Currently, the
official recommendation is that obstetricians give
unvaccinated mothers the Tdap as soon as possible after
they deliver. There does not appear to be any risk
to mother or baby if the vaccine is given during
pregnancy. It is not clear, however, if the baby
will be better protected by receiving this vaccine while
still in the womb, or whether exposure to the vaccine
before birth might make them respond a little less well
to their own series of vaccinations, thus leaving them a
little less protected overall. Dr. Richard Jacobs,
Chief of Pediatric Infectious Diseases at Arkansas
Children’s Hospital, advises that pregnant women ask
their obstetricians about the vaccine before delivery
and discuss its pros and cons. (3) The vaccine
would be avoided during the first trimester, but under
certain circumstances (like an outbreak in the
community), your OB might consider giving it in the
second or third trimester.
Please discuss this matter with your obstetrician at
your next visit. If your physician chooses to
vaccinate you after delivery, see if you can make
arrangements to receive your shot even before your first
follow-up visit. Please spread the word to other
adults who will be around your baby that they can and
should receive a dose of Tdap if it has been at least
two years since they had a tetanus booster. Don’t
forget grandparents, older teen relatives, sitters and
neighbors! Maybe in the near future deaths from
whooping cough will be a distant memory.
1. www.pertussis.com.
An informational website for parents and providers
offered by the National Association of Pediatric Nurse
Practicioners.
2.
www.cdc.gov/vaccines/ed/vpd2007/downloads/slides/Pertussis10.ppt
3. Richard F. Jacobs, MD, University of Arkansas for
Medical Sciences, Chief, Pediatric Infectious Diseases,
lecture at Fourth Annual Regional Pediatric Symposium of
the Black Hills, Rapid City, South Dakota, June 22,
2007.
 
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