By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

WHOOPING COUGH MAKING A COMEBACK, NEW BOOSTER SHOT AVAILABLE

Question: My sister recently e-mailed that her 17-year-old son had come down with whooping cough. He is being treated, and the rest of his immediate family was given antibiotics as well. I thought whooping cough was rare today because the vaccine is included in the childhood vaccines. My sister says there are a number of cases in her area. Is whooping cough making a comeback? Is it dangerous when a teenager gets it?

Answer: Whooping cough is known as pertussis in the medical field, because it’s caused by the bacteria Bordetella pertussis. This infection was first described in the 1500s and remains a common childhood illness to this day. In 2002, there were 8,296 cases of pertussis reported in the United States. The incidence has been increasing steadily since the 1980s, perhaps because not enough people got timely boosters.

Pertussis -- a highly contagious but vaccination-preventable illness -- can last for several weeks. It gets its name from the characteristic “whooping” type of cough that it produces. This illness usually starts with a runny nose, low fever and mild cough. When these symptoms first appear -- a period known as the catarrhal stage -- it is easy to confuse whooping cough with the common cold.

In the second stage, the patient begins to have bursts of rapid coughing. There can by 10 or 15 of these in rapid succession, which doesn’t allow time to take a breath. When the burst is finally over and a breath is taken, it produces the telltale high-pitched whoop.

Violent coughing spells can last for several minutes, and even cause the patient to turn blue. Sometimes the coughing leads to vomiting. This stage can last for several weeks, peaking in the second or third week. The convalescent stage is when the cough becomes less frequent and severe. This stage can last for two to three weeks.

Older people typically have milder cases of this illness, in part because they were immunized as children. The major issue for these people is usually not the threat the disease poses to them but their ability to spread it to children.

While most people make a full recovery from pertussis, it’s more likely to have severe complications for small children who have smaller and less developed airways. Seizures and inflammation of the brain -- encephalitis -- can result from lack of oxygen to the brain due to the long bouts of coughing. Pneumonia can develop as well. These complications can lead to death, particularly in infants under 6 months of age.

Once pertussis is diagnosed, the treatment is to give antibiotics to the patient and all close contacts, as your nephew’s physician did. If any of my other readers have children who have not been fully immunized, I’d suggest that you consult your family physician or pediatrician about completing their immunizations.

There is a new immunization for adults and adolescents that is a tetanus/diphtheria booster with an “acellular” pertussis vaccine added. This type of vaccine uses only the immunity stimulating parts of the bacterium and is less likely to cause side effects. The newest recommendation is to have this booster once in place of the usual tetanus/diphtheria vaccine. It is hoped that by immunizing adults and adolescents there will be fewer cases of pertussis in children.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.