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Infectious Diseases

Pertussis

Whooping cough – or pertussis – once one of the most common childhood diseases and a major cause of childhood mortality in the US, is on the rise again. Since the development and widespread use of pertussis vaccine in the 1940s, the number of cases of whooping cough has decreased significantly – more than 80%. (The pertussis vaccine is the "P" part of the DTaP vaccine young children receive. Their last booster dose is at 4-5 years of age.) However, during the past twenty years, the number of new cases has gradually risen, and in 2004, cases of whooping cough reached their highest levels since the 1950s.

Although usually thought of as a disease of infants and children, pertussis can afflict people of all ages. Those at highest risk include infants and children who have not yet received full immunization. However, older children and adults who have been immunized against pertussis may lose immunity over time, and it is not uncommon for them to become ill. The crowded conditions of middle schools and high schools provide an easy way to spread respiratory diseases such as pertussis.

Recognizing Pertussis

Early symptoms of whooping cough develop about 1 week after exposure to the bacteria and are similar to those for the common cold:

It is during this time that infected people are the most contagious, spreading the pertussis bacteria to other persons through tiny drops of airborne secretions spewed into the air during coughing and sneezing.

Within 1-2 weeks, the infected child develops severe episodes of coughing which can last more than a minute. Children may turn red or purple during these spasms. In younger children, coughing often ends with a characteristic high-pitched "whoop" noise from which pertussis gets its name, as the child tries to take a breath. Vomiting and exhaustion are common following an attack; however, the child does not appear ill between attacks.

The "whoop" is rare in children under 6 months, and not all infants cough and whoop as older children do. These infants may be red-faced and appear to be gasping for air.

The disease may be milder in older persons. Teens and adults typically have an upper respiratory infection, fever and chills, evidence of pneumonia on X-ray, and a persistent cough but no classic "whoop" as seen in younger children with smaller airways.

When to call your doctor

Complications due to pertussis can be quite serious:

For this reason, call your doctor if you suspect you or your child may have whooping cough or may have been exposed to someone with whooping cough. Non-immunized family members or children who have not received all 5 doses of vaccine are at high risk of developing whooping cough by being exposed to an infected family member. In fact, it is not uncommon for older persons in a household to be the source of infections for children within the home.

What to do during a Pertussis outbreak

There are several steps you can take to lower your risk of getting pertussis. Most importantly, make sure everyone in your home is up-to-date on their pertussis vaccines and boosters. Wash your hands

Secondly, everyone should wash their hands frequently with soap and water or antibacterial hand cleanser, especially after using tissues to handle nasal secretions or cover a cough, before eating, and after using the bathroom.

Third, have everyone cover their mouth and nose with their upper arm or tissues when coughing or sneezing.

Fourth, do not share drink containers with anyone.

And lastly, avoid crowded, enclosed areas where the likelihood of exposure to respiratory illness is greater. This is especially important for infants, toddlers, and older children, teens, and adults with poor immunity or respiratory impairment from cystic fibrosis or other chronic lung problems.

If a family member is diagnosed with pertussis, all family members and close contacts should receive an antibiotic for at least five days, depending on the medication used. Persons with the disease should not return to school or employment until five full days of treatment have been completed.

Preventing Pertussis

DTaP (tetanus, diphtheria, pertussis vaccine) immunization starts in infancy and is given in 5 doses prior to age 6. The American Academy of Pediatrics now recommends a booster immunization of the new combination vaccine (TdaP) for teens ages 11-18. Adults up to age 65 may consider re-immunization with the adult form of the pertussis vaccine. Children under age 7 should be isolated from persons known or suspected of being infected with pertussis.

References:

Pertussis (CDC)
Pertussis (ADAM Health Encyclopedia)
Whooping Cough (MedlinePlus)

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This article is a NetWellness exclusive.

Last Reviewed: Nov 14, 2007

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University