Whooping cough - or pertussis - is an infection of the
respiratory system
caused by the bacterium
Bordetella pertussis
(or
B. pertussis
). It's characterized by severe
coughing
spells that end in a "whooping" sound when the person
breathes in. Before a
vaccine
was available, pertussis killed 5,000 to 10,000 people in the
United States each year. Now, the pertussis vaccine has reduced the
annual number of deaths to less than 30.
But in recent years, the number of cases has started to rise. By
2004, the number of whooping cough cases spiked past 25,000, the
highest level it's been since the 1950s. It's mainly
affected infants younger than 6 months old before they're
adequately protected by immunizations, and kids 11 to 18 years old
whose immunity has faded.
Signs and Symptoms
The first symptoms of whooping cough are similar to those of a
common cold:
- runny nose
- sneezing
- mild cough
- low-grade fever
After about 1 to 2 weeks, the dry, irritating cough evolves into
coughing spells. During a coughing spell, which can last for more
than a minute, the child may turn red or purple. At the end of a
spell, the child may make a characteristic whooping sound when
breathing in or may vomit. Between spells, the child usually feels
well.
Although it's likely that infants and younger children who
become infected with
B. pertussis
will develop the characteristic coughing episodes with their
accompanying whoop, not everyone will. However, sometimes infants
don't cough or whoop as older kids do. They may look as if
they're gasping for air with a reddened face and may actually
stop breathing for a few seconds during particularly bad
spells.
Adults and adolescents with whooping cough may have milder or
atypical symptoms, such as a prolonged cough without the coughing
spells or the whoop.
Contagiousness
Pertussis is highly contagious. The bacteria spread from person
to person through tiny drops of fluid from an infected person's
nose or mouth. These may become airborne when the person sneezes,
coughs, or laughs. Others then can become infected by inhaling the
drops or getting the drops on their hands and then touching their
mouths or noses.
Infected people are most contagious during the earliest stages
of the illness up to about 2 weeks after the cough begins.
Antibiotics shorten the period of contagiousness to 5 days
following the start of antibiotic treatment.
Prevention
Whooping cough can be prevented with the pertussis
vaccine
, which is part of the DTaP (diphtheria, tetanus, acellular
pertussis) immunization. DTaP immunizations are routinely given in
five doses before a child's sixth birthday. To give additional
protection in case immunity fades, the AAP now recommends that kids
ages 11-18 get a booster shot of the new combination vaccine
(called Tdap), ideally when they're 11 or 12 years old, instead
of the Td booster routinely given at this age. As is the case with
all immunization schedules, there are important exceptions and
special circumstances. Your doctor will have the most current
information.
Experts believe that up to 80% of nonimmunized family members
will develop whooping cough if they live in the same house as
someone who has the infection. For this reason, anyone who comes
into close contact with someone who has pertussis should receive
antibiotics to prevent spread of the disease. Young kids who have
not received all five doses of the vaccine may require a booster
dose if exposed to an infected family member.
Incubation
The incubation period (the time between infection and the onset
of symptoms) for whooping cough is usually 7 to 10 days, but can be
as long as 21 days.
Duration
Pertussis can cause prolonged symptoms. The child usually has 1
to 2 weeks of common cold symptoms, followed by approximately 2 to
4 weeks of severe coughing, though the coughing spells can
sometimes last even longer. The last stage consists of another
several weeks of recovery with gradual resolution of symptoms. In
some children, the recovery period may last for months.
Professional Treatment
Call the doctor if you suspect that your child has whooping
cough. To make a diagnosis, the doctor will take a medical history,
do a thorough physical exam, and take nose and throat mucus samples
that will be examined and cultured for
B. pertussis
bacteria.
Blood tests
and a chest X-ray may also be done.
If your child has whooping cough, it will be treated with
antibiotics, usually for 2 weeks. Many experts believe that the
medication is most effective in shortening the infection when
it's given in the first stage of the illness,
before
coughing spells begin. But even if antibiotics are started later,
they're still important because they can stop the spread of the
pertussis infection to others. Ask your doctor whether preventive
antibiotics or vaccine boosters for other family members are
needed.
Some kids with whooping cough need to be treated in a hospital.
Infants and younger children are more likely to be hospitalized
because they're at greater risk for complications such as
pneumonia
, which occurs in about 1 in 5 children under the age of 1 year who
have pertussis. Up to 75% of infants younger than 6 months old with
whooping cough will receive hospital treatment. In infants younger
than 6 months of age, whooping cough can even be
life-threatening.
While in the hospital, a child may need suctioning of thick
respiratory secretions. Breathing will be monitored and oxygen
given, if needed. Intravenous (IV) fluids might be required if the
child shows signs of dehydration or has difficulty eating.
Precautions will be taken to prevent the infection from spreading
to other patients, hospital staff, and visitors.
Home Treatment
If your child is being treated for pertussis at home, follow the
schedule for giving antibiotics exactly as your doctor prescribed.
Giving cough medicine probably will not help, as even the strongest
usually can't relieve the coughing spells of whooping
cough.
During recovery, let your child rest in bed and use a cool-mist
vaporizer to help loosen respiratory secretions and soothe
irritated lungs and breathing passages. (Be sure to follow
directions for keeping it clean and mold-free.) In addition, keep
your home free of irritants that can trigger coughing spells, such
as aerosol sprays, tobacco smoke, and smoke from cooking,
fireplaces, and wood-burning stoves.
Kids with whooping cough may vomit or not eat or drink much
because of frequent coughing. So offer smaller, more frequent meals
and encourage your child to drink lots of fluids. Watch for signs
of dehydration, too, including thirst, irritability, restlessness,
lethargy, sunken eyes, a dry mouth and tongue, dry skin, crying
without tears, and fewer trips to the bathroom to urinate (or in
infants, fewer wet diapers).
When to Call the Doctor
Call the doctor if you suspect that your child has whooping
cough or has been exposed to someone with whooping cough, even if
your child has already received all scheduled pertussis
immunizations.
Your child should be examined by a doctor if he or she has
prolonged coughing spells, especially if these spells:
- make your child turn red or purple
- are followed by vomiting
- are accompanied by a whooping sound when your child breathes
in after coughing
If your child has been diagnosed with whooping cough and is
being treated at home, seek immediate medical care if he or she has
difficulty breathing or shows signs of dehydration.
Reviewed by:
Cecilia diPentima, MD
Date reviewed: October 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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