Respiratory Disorders

Whooping Cough (Pertussis)

What is whooping cough (pertussis)?

Whooping cough, or pertussis, mainly affects infants and young children. Caused by a bacterium, it is characterized by paroxysms (intense fits or spells) of coughing that end with the characteristic whoop as air is inhaled. Whooping cough caused thousands of deaths in the 1930s and 1940s, but, with the advent of the pertussis vaccine, the rate of death has declined dramatically. Recent epidemics have occurred in areas where vaccine rates have fallen.

What causes whooping cough?

Whooping cough is caused by a bacteria called Bordetella pertussis. It is spread through children from exposure to infected persons through droplets in the air. Once the bacteria is in the child's airways, swelling of the airways and mucus production begins.

This disease can be prevented with proper immunizations using the pertussis vaccine. This is usually part of the DTaP vaccine - or the diphtheria, tetanus, and pertussis. This vaccine is usually given to children at 2, 4, 6, and 15 to 18 months of age, with a booster at 4 to 6 years of age. The acellular pertussis vaccine now recommended produces fewer adverse reactions than the older vaccine.

Facts about whooping cough:

• Although the disease can be prevented with the vaccine, it does still occur (because of the children who are not vaccinated).
  
  
• Whooping cough usually affects children younger than 1 year.
  
  
• Twenty-four percent of children affected are under age 1.

What are the symptoms of whooping cough?

The disease usually takes one to three weeks to incubate, with the child usually passing through three stages. The following are the most common symptoms of whooping cough, according to each stage. However, each child may experience symptoms differently. Symptoms may include:

• catarrhal stage (often lasts one to two weeks):
  
  
  • mild cough
  • low grade fever
  • runny nose
    
    
• acute phase (may last for several weeks):
  
  
  • cough gets worse and comes in severe fits
  • cough is dry and harsh
  • cough ends with a whoop sound on inspiration
  • child may vomit with the coughing and appear to be strangling on the vomit
  • cough can be started by many factors, including feeding, crying, or playing
    
    
• recovery phase (usually begins around the fourth week):
  
  
  • vomiting and the whooping cough cease first
    
    
  • the cough usually decreases around the sixth week, but may continue on occasion for the next one to 2 months

Whooping cough can last up to several weeks and can lead to pneumonia.

The symptoms of whooping cough may resemble other medical conditions. Always consult your child's physician for a diagnosis.

How is whooping cough diagnosed?

In addition to a complete medical history and physical examination, diagnosis of whooping cough is often confirmed with a culture taken from the nose.

Treatment for whooping cough:

Specific treatment for whooping cough will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent of the condition
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

In many cases, the child may be hospitalized for supportive care and monitoring. Sometimes, oxygen and intravenous (IV) fluids are needed until the child begins to recover. Antibiotic treatment (i.e., clarithromycin [Biaxin®] or azithromycin [Zithromax®], or a related antibiotic) may also be ordered by your child's physician.

Family members and other people who have been in close contact with the child usually are started on antibiotic therapy, regardless of whether they have received the vaccine or not.

Other treatment may include the following:

• keeping your child warm
• eating small, frequent meals
• increased fluid intake
• reducing stimuli that may provoke coughing

Preventing whooping cough:

Although a vaccine has been developed against whooping cough, which is routinely given to children in the first year of life, cases of the disease still occur, especially in infants younger than 6 months of age.