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August 9, 2010
Outbreaks of whooping cough growing across U.S.

Whooping cough - or pertussis - is an infection of a person's respiratory system caused by the bacterium Bordetella pertussis (or B. pertussis). This disease is known for its severe coughing spells that end in a "whooping" sound when the person breathes in.

"There are growing outbreaks of whooping cough across the country, which are due in part to gaps in vaccination practices that may be contributing to this preventable disease," explained Pediatrician Laurie Penix, M.D. "There's some evidence that being under-vaccinated or not vaccinated at all is contributing to a portion of the cases in the California outbreak and in other areas."

Rising cases of the disease have been reported in Idaho, Texas, South Carolina, Michigan and in California, where 1,500 children have been diagnosed in what's being called the worst outbreak in 50 years. In some places, including Michigan and California, there are communities where parents have refused recommended vaccinations, often because they fear complications from the shots.

"Whooping cough has mainly affected infants younger than 6 months old before they're adequately protected by immunizations," Dr. Penix continued. "In addition, it is also affecting children ages 11 to 18 years old whose immunity has faded and who have not yet received their additional recommended vaccine doses as adolescents."


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.

"Infected people are most contagious during the earliest stages of this illness, which is up to about 2 weeks after the cough begins," she said. "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 become infected by inhaling the drops or getting them on their hands and touching their mouths or noses. Antibiotics shorten the period of contagiousness to 5 days following the start of antibiotic treatment."

The first symptoms of whooping cough are similar to those of a common cold:

-runny nose


-mild cough

-low-grade fever

"A child usually has one to two weeks of these symptoms, followed by approximately 2 to 4 weeks of severe coughing, although the coughing spells can sometimes last even longer," Dr. Penix advised. "These spells can last for more than a minute and the child may turn red or purple. At the end of a spell, the child may make a whooping sound when breathing in or may vomit. Between these spells, the child usually feels well. However, there is often several weeks of recovery involved as the symptoms lessen."

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 all children do. "Infants may look as if they're gasping for air and have a red face, or they may actually stop breathing for a few seconds during particularly bad spells," Dr. Penix stated. "Adults and adolescents with whooping cough may have milder or atypical symptoms, such as a prolonged cough without the coughing spells or the whoop."


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 America Academy of Pediatricis now recommends that kids ages 11-18 get a booster shot of the 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, and your doctor will have the most current information. Some schools are requiring Tdap before students enter the seventh grade.

Experts believe that up to 80% of non-immunized 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 help prevent spread of this disease. Young children who have not received all five doses of the vaccine may require a booster dose if exposed to an infected family member.

"If your child has whooping cough, it will be treated with antibiotics, usually for 2 weeks," Dr. Penix concluded. "Many experts believe that antibiotics are most effective in shortening the duration of the infection when it's given in the first stage of the illness, before the 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."

Laurie Penix, M.D., is board certified in pediatrics and pediatric infectious diseases. She is affiliated with the Salem Pediatric Care Center at 2020 East State Street in Salem, 330-332-0084.



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