Dr. Molly’s Weblog

Molly O’Shea starts a revolution in pediatric care

The final word on pertussis for now March 5, 2009

Filed under: Uncategorized — Dr Molly OShea @ 10:26 pm

Over the last two weeks in my office I have seen four cases of pertussis, or whooping cough. One of the four children had received no vaccines, but the other three were fully vaccinated and still young enough (between the ages of 7-10) that their immunity from the vaccine should still be in full effect. In August, I had four other cases of whooping cough with the same distribution of vaccinated to unvaccinated kids, which has now caused me to worry more about any child who comes in with significant cough.

Most kids get the DTaP vaccine during infancy and boosters at around 12-18 months, 4-5 years and 11-12 years. Teenagers and adults should get the vaccine as well every ten years or so since immunity will wane and they will be at greater risk contracting the illness if exposed. The “P” of the vaccine protects against pertussis, also known as the whooping cough. The problem is that the vaccine isn’t perfect and about 12-20% of the kids that get the vaccine won’t develop adequate immunity to whooping cough. Back when virtually everyone got the vaccine, this wasn’t such a big deal because even those folks who didn’t respond were protected in a way by the fact that the illness was much less prevalent because everyone else was immune. Now with more parents opting to delay or not give vaccines, we are seeing a real uptick in the incidence of whooping cough in children.

Pertussis in one of the most contagious illnesses around. According to Dr. Basim Asmar, chief of the Division of Infectious Disease at Children’s Hospital of Michigan, almost all people who are not immune to whooping cough who are exposed to it will get it. That means those 12 percent-20 percent of vaccinated kids are doomed to illness if they get exposed as are all unvaccinated people and anyone older whose immunity has diminished over time.

The illess is spread through droplets coughed in your face and then inhaled. If your child has been exposed to the whooping cough, it takes about seven-10 days for the symptoms of illness to appear. the The illness can be averted if antibiotics are taken during this incubation period. The bacteria can’t live for any length of time on surfaces or clothing, so you needn’t worry about toys and clothing but rather just direct exposure to the child in who is infected.

Given the fact that the incidence is on the rise, what should a parent look for? Pertussis initially looks like a mild cold with some cough. It has less runny nose than the winter viruses and fever is not that common with it. After a week or two ,the cough begins to get dramatically worse and is associated with severe coughing jags day and night. The cough can be severe enough to cause vomiting, broken blood vessels in the white of the eye and on the skin around the eyes, a loud intake of air after the jag (the “whoop”) and even cracked ribs from coughing. This severe coughing phase can last two-four weeks followed by another month or so of slow, gradual recovery with diminishing cough and fatigue.

As bad as this all sounds, it can be worse. Infants, especially under 6 months of age, can stop breathing as a result of the illness and up to 5 percent of the smallest infants will die as a result. People of any age can develop pneumonia as a complication, which you might imagine makes the coughing even worse. Many people end up hospitalized for dehydration because eating and drinking can trigger severe coughing and vomiting, while others end up in the hospital for supplemental oxygen. It is one bad illness.

Whooping cough can be tested for by taking a sample of snot from the back of the nose and sending it to a lab for a test called a pertussis PCR. It is much more sensitive than a culture and allows for a more rapid diagnosis, getting an answer in about two-three days.

So if your child has a coughing illness that is lasting more than a week and still getting worse, especially if he or she is not vaccinated, pertussis needs to be on the list for serious consideration. If the test comes back positive, your child will need to be put on a course of antibiotics to decrease the spread to others and the antibiotics may decrease the severity of the illness. Also, all of the people the child comes in contact with in the household need to be put on antibiotics as do other close contacts for prophylaxis. For example, if your child has had a sleep over during the illness, all of the other kids should be put on antibiotics in the hopes of preventing the illness.

Be aware of your risks, get your shots, and remember that even grown ups need em and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center



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