Our Best Defense against Whooping Cough

by Marissa Camilon, MD 2011 | camilon@myhousecallmd.com

Outbreak? What outbreak?

You may have seen the commercials and heard the rumors. It’s true. In California, we are in the middle of an “outbreak” of Whooping cough. On August 24, 2010 the California Department of Health reported a 7-fold increase in the number of cases of Whooping cough over the past year.  This puts California at the highest number of cases in the past 52 years. With that being said, this is a big deal for Californians and a potential “big deal” for the rest of the country.

Who is being affected?

Of those being hospitalized by Whooping cough, 75% of patients were less than 6 months old…right, not you.  While Whooping cough has been shown to be more fatal amongst younger individuals (seven of the reported eight deaths occurred in infants less than 2 months old), the infection affects people of any age.  We have seen a greater number of cases in infants and children aged 7-18 years.


What is whooping cough anyways?

Whooping cough, caused by the organism Bordetella pertussis, is a highly contagious condition spread by droplets that carry bacteria (yes, that horrible stream of mist that flies across the room when you sneeze or cough).  It is named after its characteristic presenting symptom seen in infants.  Classically, patients present to the doctor with severe episodes of coughing, often causing infants to change to a blue or dark red color immediately after a coughing spell, ending with a “whoop” of air as patients take a deep breath.  In older individuals, we often don’t see the “whoop” that the condition is known for.  Instead, older children and adults have severe coughing episodes that can be associated with color change or vomiting from strong stimulation of the gag reflex.  Patients can even develop bleeding in a chamber of their eyes from the high pressure caused by the coughing fits.  Because this condition is difficult to diagnose, lasts for a long time and can be milder in older children and adults, infected individuals are a significant means of infection for younger children.

Antibiotics and supportive care (i.e. TLC) are the mainstays of treatment for this condition. Antibiotics are given to patients to lessen the associated symptoms and decrease the risk of that individual spreading the infection.  Because of its high rate of infection, we also commonly give an entire family or any close contacts a course of antibiotics to help stop the spread of disease.  The coughing episodes caused by the infection, however, can last for months, even after treatment.  It’s miserable, we know.

What do we do now?

The main defense against Whooping cough is vaccination. Current recommendations include five doses of DTaP before the age of 4-6 years.  This vaccine also protects against Diphtheria and Tetanus (two more bugs you don’t want). Though we have been vaccinating children against Pertussis since the 1940s, the cause of this recent outbreak remains unknown.  Some point towards the rising trend of parents abstaining from vaccinations, while others believe it is the body’s waning immunity to the infection years after receiving the vaccine. In the past we have seen small outbreaks of Pertussis in communities affecting people approximately 5-10 years after the DTaP vaccines was given, leading the Advisory Committee on Immunization Practices to recommend an additional adult booster in 2006. For children older than 7, a different combination of the vaccines, called Tdap, is now used.

Due to the current outbreak in California, the Department of Health recommended a booster vaccine in certain segments of the population. These populations include all women of childbearing age, those in close contact of infants, health care personnel and those with open wounds.  This recommendation also applies those who are currently pregnant, as the vaccine can be given during the second or third trimester.  The only reason to not get the vaccine would be if you have a history of a severe allergic reaction to vaccines or a history of developing encephalopathy seven days after receiving the vaccine.  The most common side effect of the vaccine is a local inflammatory reaction at the site of injection.  Way less miserable than Whooping cough.

Doing Your Part

While this outbreak affects the youngest members of our population to the greatest degree, it is actually the actions of older individuals that can stop the high rate of infection.  We can either by update our own vaccines or take those who may be infected to the hospital as quickly as possible.  Until the medical community has the opportunity to update its current vaccine recommendations and improve our immunity as a whole, we all need to do our part to stop this deadly disease.

Resources:

  1. California Department of Public Health. “Pertussis Vaccination Recommendations 2010.” http://eziz.org/PDF/CDPH%20Pertussis%20Immunization%20Policy%20July%202010.pdf
  2. California Department of Public Health. “Pertussis Report 8/24/2010” http://www.cdph.ca.gov/programs/immunize/Documents/Pertussis%20report%208-24-2010%20-%20For%20Release.pdf
  3. Khan, F., et al. “Case-Control Study of Vaccination History in Relation to Pertussis Risk During an Outbreak Among School Students.” Pediatr Infec Dis J, 2006. 25: 1132-36.
  4. Wei S., et al. “Effectiveness of Adolescent and Adult Tetanus, Reduced-dose Diphtheria, and Acellular Pertussis Vaccine against Pertussis.” Clinical Infectious Diseases, 2010. 51(3): 315-321.

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