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Medically Speaking
"Forgotten, But Not Gone"
by Margaret Trexler Hessen, M.D., specialist in infectious diseases & member of the Delaware County Medical SocietyRemember whooping cough? Chances are that if you’re not a senior citizen, you don’t - as childhood vaccination against whooping cough (or pertusiss) has been a standard procedure for many years, and made the disease relatively uncommon in the United States for decades after it was introduced.
As we have recently discovered with some other diseases (such as measles), however, vaccination may not result in lifelong immunity. The Centers for Disease Control has noted an increase over the last few years in whooping cough and a related illness (parapertussis), primarily in adolescents and adults. They theorize that while young children have strong immunity from vaccine (the “P” of the DTP or DTaP series given as part of standard childhood vaccine series), levels of immunity decline as the years pass, leaving older adolescents and adults relatively unprotected.
Why be concerned? The disease is lengthy and can result in significant loss of time in school or at work. More importantly, it can be spread from an infected adolescent or adult to a baby too young to have been vaccinated fully, and the disease may be much more severe (even fatal) in infants.
When should whooping cough be suspected? The disease often begins just as any other “cold” with low grade fever, “runny nose” watery eyes. After a few days, a dry cough develops. The severity and duration of the cough are clues to the diagnosis. Long fits of coughing result in loss of breath, followed at last by a deep and sudden intake of breath that causes the “whooping” sound heard in children. Vomiting may occur at the end of a coughing spell. The cough typically lasts well over a month. Complications of the disease include pneumonia, ear infections, broken ribs, and hernias.
It used to be thought that antibiotics were of little value in treating this disease, but newer information indicates that antibiotics given for a full 2 week period can reduce the length and severity of the illness. They may also reduce the contagious period. Infants and those with complications may require hospitalization.
As with most disease, prevention is the best medicine. Childhood vaccination, while not producing lifetime immunity, is still vitally important and effective early in life when the disease is likely to be most severe. Some years ago, the pertussis component of the DTP vaccine caused high fever and irritability in some children, and was suspected of causing permanent brain damage in a very small number of children.
The vaccine that is used today is a different preparation (“acellular” pertusiss) and is safer and much better tolerated. Clearly, the risk of the disease is greater than the risk of the vaccine, and all children should be vaccinated. Boosters are recommended at various intervals during childhood, and parents should check to see whether their children are up to date on these booster doses. Unfortunately, there is currently no vaccine available for older adolescents for adults, although research is underway. However, as noted above, treatment is available and effective, and anyone with the symptoms described above should seek medical evaluation.
Note: this article is presented through the efforts of the Delaware County Medical Society and is intended for informational purposes only, the contents should not be intended as medical advice. “You and Your Doctor – Preserve the Relationship”.
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