Pertussis (“Whooping Cough”)

A bacteria that’s spread by coughing.  Small babies with Pertussis get very sick, may turn blue, and sometimes die.  Fortunately they can get a vaccine once they’re 6 weeks old.  Older children and adults never get that sick, but can have a 10-week cough, and spread the germ.

There are no special clinical findings for pertussis; thereโ€™s no fever, and lung exam usually sounds normal.  Babies have a classic course: 2-3 weeks of runny nose, which turns into a cough thatโ€™s so bad they โ€œwhoopโ€ to gasp for air.  But in teens & adults, the cough is milder, without any lead-in.

The worse the coughing spells, especially if they provoke actual vomiting, the more likely it’s pertussis.  Viral Tracheitis also causes cough without runny nose or any sign on exam, but isnโ€™t as severe and only lasts 1-2 weeks at most.

The Centers for Disease Control and Prevention (CDC), our national public health agency, considers Pertussis when a cough has been going on over 2 weeks.  Problem is, that antibiotics only help shorten symptoms if given sooner.  Also, to prevent contagion, treatment after 2 weeks is nowhere near as effective as earlier.

Another problem: tests arenโ€™t so easy or accurate.  We have to use a special kit (available from health departments).  The quickest test (PCR) is expensive, and may give false-positive results.  The standard culture takes time, may be false-negative, & is easily spoiled if not processed right.

So most clinicians I know deal with pertussis clinically.  But we certainly donโ€™t want to give antibiotics to everyone with a cough.  I limit my diagnosis to patients with significant cough and no upper respiratory symptoms (like runny nose), a normal lung examination (by stethoscope), and any of the following:

  • Coughing spells that provoke vomiting
  • Cough lasting over 2 wks. without any improvement
  • Contact with unvaccinated infants

The last is my most important.  Pertussis in school-age children, teens, and adults gets better on its own.  But Iโ€™d never want it spread to a baby (or a woman in the last half of pregnancy, although all pregnant women get vaccinated these days).  Infants require 3 shots for protection, at 2, 4, and 6 months of age.

Itโ€™s faddish in some communities (usually upper-middle-class) to refuse childhood vaccination.  Years ago there was rumor of association with autism, though studies have convincingly refuted and debunked any possible connection.  Since autism occurs in young children (thatโ€™s who we immunize), there are certainly cases of it occurring soon after vaccination.  And the internet provides fertile dissemination of โ€œtestimonials.โ€  Pediatricians donโ€™t even argue with parents anymore — it’s too time-consuming trying to change the mind of true-believers.

During a recent measles outbreak, a woman with leukemia, whose weakened immune system caused her childhood measles vaccine to lose its effect, got infected and died.ย  An unvaccinated local resident who had just had mild measles, and was likely not the person who infected her, felt potentially guilty enough to reflect publicly.

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