The 100 Day Cough

California hit a record of sorts this year. The childhood ailment ‘Whooping Cough’ or ‘Pertussis’ hit epidemic levels in the state in the first 6 months of this year. From Jan 1st through June 10th, 3400 new infections where reported to authorities.  The last epidemic happened in 2010. The disease seems to be reappearing in the area every 3-5 years in these outbreaks. It’s not that you find pertussis in California alone though it hits 48 million people a year all over the world. It kills 295,000 of them.

What is Whooping Cough?

Commonly known as “Pertussis” in the medical world…the disease is caused by the tiny speck of a bacterium known as Bordetella pertussis. It’s a pretty nasty little speck though, and very highly contagious. The little devils look like short round barrels under a microscope and they have a nice thick capsule, almost like a wool coat, granting protection from the elements and the immune system alike.

They really love fresh air, oxygen really. They tend to grow and congregate in the throat, trachea and lungs for that very reason. At first the symptoms are mild, but the infection has many phases usually within a week to 10 days a baby (typically around 2 months if age) will develop violent coughing fits. Some fits are so strong and last so long that it prevents the baby from breathing in. The face can turn purple or blue during the fit.

When you can’t catch your breath between coughs, the lungs empty out really fast, eventually though the fit will end and the child gulps in air quickly and messily, the indrawn breath sounds like a whoop.

The coughing stage can last for 6 weeks or more and is usually treated with antibiotics to shorten it. In the pre-antibiotic era the infection could last for 3 months or more.

What to do

A cough like this, young or old is never a wait and watch situation. Get to a Clinic / Urgent care / ER wherever when the whooping happens. Antibiotics, steroids, x-rays and oxygen are all treatments that will be discussed with you. The trick is to open the airway up and allow the patient to breath without having to taking heaving gulps and use all that energy.

Prevention

There are several formulations of vaccines used to prevent pertussis. Usually the vaccine for this bug is combined with the vaccine for Diphtheria as well as Tetanus.

Some of these formulations are combined with vaccines to prevent other diseases and reduce the total number of shots that someone receives at one office visit.

In the U.S., these are the vaccines are most commonly used.

1. DTaP
2. Tdap

• The DTaP is given to children younger than 7 years of age, and two Tdap and Td are given to older children and adults. Children should get 5 doses of DTaP, one dose at each of the following ages: 2, 4, 6, and 15 through 18 months and 4 through 6 years.
• Tdap: Adolescents 11 through 18 years of age (preferably at age 11-12 years) should receive a single dose of Tdap. One dose of Tdap is also recommended for adults 19 years of age and older who did not get Tdap as an adolescent. Expectant mothers should receive Tdap during each pregnancy, preferably at 27 through 36 weeks. Tdap should also be given to 7-10 year olds who are not fully immunized against pertussis. Tdap can be given no matter when Td (a booster for Tetanus and Diphtheria alone) was last received.