Finishing up my patients for the day, I was thinking of the vacation ahead. I didn’t reflect much on the runny nose and slight cough I’d had for past couple of days – probably just a little cold. That all changed a few days into the trip – though I still didn’t feel too bad overall, I was having prolonged bouts of coughing that left me gasping. By the time I’d realized I had whooping cough (WC), also known as pertussis, most of my family was starting down the same road. The next several weeks were marked by racking coughs during the day and awakenings at night by children who had coughed until they vomited. In the end, this trip became affectionately known as “the vacation from hell.”
Whooping cough gets its name from the “whooping” sound that is made when gasping for air after a fit of coughing. It is sometimes called “the 100 day cough” but we counted it to be closer to 120 or 130 days.
That was some 20 years ago. Over the last several years here in Maryville I’ve barely needed to do a test for whooping cough. But over the last couple of weeks, we’re suddenly getting a steady stream of folks showing the symptoms, and many are testing positive.
Worldwide there are still an estimated 30-50 million cases of WC yearly with about 300,000 deaths. Pertussis is particularly prevalent in the many nations where vaccination rates are low. One study found that, in eight countries where immunization coverage was reduced, incidence rates of pertussis surged to 10 to 100 times the rates in countries where vaccination rates were sustained.
In the U.S., before pertussis immunizations were available, nearly all children developed whooping cough. Between 150,000 and 260,000 cases of pertussis were reported each year, with up to 9,000 pertussis-related deaths. Since the onset of routine vaccination, pertussis has fallen to about a 10th of that number of cases and last year, for comparison, there were 18 deaths from pertussis. Case numbers show that children who haven’t received pertussis vaccine are at least 8 times more likely to get pertussis than children who received all 5 recommended doses.
The majority of deaths occur among infants younger than 3 months of age and more than half of infants less than 1 year of age who get pertussis are hospitalized. That’s why, besides the need to start vaccination of infants promptly at 2 months of age, vaccination of preteens, teens and adults – including pregnant women – is especially important for families with new infants.
Here’s the tricky thing about WC: It starts just like a cold, followed a few days later by an increasing cough. So at first, you really can’t tell it’s anything serious. By the time the cough has really shown itself to be whooping cough, antibiotics (such as azithromycin and other relatives of erythromycin) only slightly change the course of the illness. Antibiotics do at least render the person non-infectious which is no small thing given how highly contagious this coughing illness is.
So, what are the take-home messages? Old illnesses like WC are still around and can rear their ugly heads, especially when vaccination rates fall. So be sure and protect yourself and your kids with timely immunization. When WC is around, there is no need to panic, but even minor respiratory symptoms need to be checked out early to stop the progress of this miserable, and potentially dangerous, malady.
Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835