Whooping Cough–Old Disease, New Epidemic

Whooping Cough Pertussis

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The Centers for Disease Control (CDC) in Atlanta recently confirmed what many health care providers suspected: There’s been a dramatic increase in the number of cases of whooping cough in the US. An acute respiratory illness caused by the bacterium Bordatella pertussis, whooping cough–or, as it is more properly known, pertussis–has already exceeded 18,000 cases this year, and promises to rise to levels not seen in more than 50 years. And yet it’s a disease most of us have been vaccinated against. Why is this happening?

About Pertussis

First, a few words about the disease itself. Pertussis is highly contagious; transmission within households approaches 100 percent. It almost always presents in a manner indistinguishable from the common cold, but then one to two weeks later, it enters the so-called paroxysmal phase, typified by severe coughing spasms followed by an inspiratory whooping sound (hence the name “whooping cough”). The spasms can be dramatic, associated with bulging eyes and neck muscles, and vomiting. In fact, the spasms can be so severe that the force of the coughing can cause a hernia! A long convalescent phase follows, during which the cough slowly abates, but for many months afterward, a routine viral infection can potentially trigger a recurrence of paroxysmal coughing.

Treatment with antibiotics has little to no impact on the course of the disease itself, but it does prevent the spread. Because the disease can be particularly severe in infants and young children–sometimes leading to hospitalization with severe complications–it’s critical to prevent the disease from spreading to other family members.

Why Is Pertussis on the Rise?

So why the sudden increase in the number of cases? We aren’t certain, but it appears that the newer vaccines have a slightly lower efficacy and shorter duration of action than the ones used into the 1990s. Pertussis is one of three components in the well-known DTaP and TDap vaccines (the three components include pertussis, tetanus, and diphtheria). The DTaP vaccine is routinely given to children and TDaP is recommended as a booster later in life.The earlier vaccine, DTwP, was capable of stimulating a stronger and longer-lasting immune response than the current vaccines, but it’s no longer used because of an unacceptably high risk of severe side effects. The vaccines we use today are very well tolerated but, unfortunately, are a little less potent–and the lessened immune effect leads to a greater risk of contracting the disease. This lessened immunogenicity, along with many people never having been vaccinated, are probably the primary causes of the current upsurge in the number of pertussis cases.

When to Seek Help

Pertussis is rarely suspected and diagnosed in its early days when it resembles a common cold, but if the symptoms of your cold don’t abate within a couple of weeks and instead progress to severe attacks of coughing, with or without the notorious whoop, see your health care provider. You may not have pertussis–there are other conditions that can cause an unexpected exacerbation that may also need treatment–but you definitely need to be checked out. If you have pertussis, antibiotics likely won’t help you, but they may help protect your family and friends. And please don’t forget to make sure your vaccinations are up to date!

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The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, the San Francisco Bay Area, Seattle, and Washington, DC.

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