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Hilliard Pediatrics, Inc. - Dr. Tim Teller, MD
Whooping cough or pertussis is a bacterial infection causing a prolonged cough. It is caused by bacteria called Bordetella pertussis. Whooping cough is on the rise in recent years. From 2011 to 2012, the State of Washington went from 50 cases to 4000 cases in one year. Before the vaccine against whooping cough became available, the U.S.A. averaged 300,000 cases and 10,000 deaths per year.
Whooping cough is spread through coughing from person to person. Most cases are in infants and 10-18 year olds, but can occur at any age. As many as 80% of those exposed in a household will develop whooping cough. The number of children who would develop whooping cough after an exposure at school, daycare, or other place outside the home is less than this 80%.
The increase in whooping cough is related to the increase in the number of families nationwide delaying or avoiding vaccines for their children. This is true in the State of Washington.
The vaccine for whooping cough is given routinely at 2 months, 4 months, 6 months, 15 months, 5 years of age, 10-12 years of age, and then as a booster dose every 10 years. The vaccine is given with the vaccines for tetanus and diphtheria as a “DTaP” (the “P” stands for pertussis) or “Tdap” if older than 6 years of age. The vaccine gives people good but not great protection against whooping cough. A fully immunized child or adult can still become ill with whooping cough when exposed to the bacteria.
Adults who have not had the whooping cough vaccine in the last 10 years are at significant risk for becoming sick from whooping cough. Many adults have more mild symptoms but can then spread the bacteria to others, especially children, who may become much more ill.
An infant or child with a “full blown” case of whooping cough shows symptoms 7-10 days after being exposed to the germ. For the first two weeks, there are typical “cold” (viral upper respiratory infection) symptoms that are no different than a usual “cold”: runny nose, mild cough, nasal congestion, and possibly reddened white of the eyes (without thick eye discharge). For the next 2 or more weeks, there will be an intermittent dry, hacking cough. A series of forceful coughs after one breath in will happen, sometimes with a “whooping” sound at the end of coughing spell when the child tries to catch their breath. Very young infants rarely make the “whoop”, but may have gagging, gasping, apnea (brief periods when their breathing stops), and a blue color around the mouth and face. During this time, some children cough so forcefully that they will have broken blood vessels in the white of the eyes and small pin-point red dots on their face, neck, and chest called petechiae. This stage of the illness is followed by a long period of time (weeks or months) when the cough gradually lessens, although it may worsen again if the child is exposed to a new “cold” virus. Fever is not usually seen during a whooping cough illness, except when another infection is also present at the same time (such as an ear infection).
A child or adult who is fully immunized with the pertussis vaccine may have an illness not that different from a typical cough and cold, sinusitis, bronchitis, or walking pneumonia. The most likely things to make us concerned with whooping cough in this situation are these following things:
The test for whooping cough is done in the office (or urgent care or emergency department) by a physician or nurse practitioner. It is a swab done in the back of the nose (“nasopharyngeal”) with two soft plastic swabs. We send the swabs off to the lab at Nationwide Children’s Hospital and typically get the results the next day. When we get the results, we will call you whether the test shows pertussis (“positive”) or not (“negative”). If your child is found to have whooping cough and has not been started on antibiotics, we will call in the antibiotics to the pharmacy.
Last Updated: 06/2019