Pertussis—or whooping cough—is one of those illnesses many Americans no longer take seriously. Once a vaccine became widely available in the 1940s, the highly contagious infection was rarely diagnosed in the United States; fewer than 1,000 cases were reported in 1976.
But by 2012, that number had risen to nearly 42,000. The Centers for Disease Control and Prevention has reported that a decrease in immunization of young children, and waning immunity in adults, has contributed to this resurgence.
Initially, pertussis symptoms may resemble those of a mild cold: runny nose, fever and mild cough. But the cough persists weeks later. And eventually that cough, with its distinctive “whoop” sound, worsens, with patients sometimes vomiting or struggling to catch their breath during the coughing fits, or spasms. Since the first pertussis vaccine is not administered until babies are 2 months old, infants are especially susceptible when exposed to whooping cough.
Jana Shaw, M.D., a pediatric infectious disease specialist at Upstate Golisano Children’s Hospital in Syracuse, is at the local front line of the resurgence. She spoke with Family Times recently about why she believes immunization for pertussis should be encouraged. (This interview has been edited and condensed.)
Family Times: Some states saw notably more pertussis last spring and summer. Have you seen an upsurge?
Jana Shaw: Pertussis remains a concern. Although we did not see any cases over the summer, it comes up every year. Some more than others—which is not surprising because it is an infection that comes in sort of cyclical epidemics. It seems to return every three to five years in our communities.
Measles is another highly contagious disease. I mention that because it is critically important that children in school settings be fully vaccinated. Vaccines are the best tools we have to protect school-aged children.
Since the vaccines have been developed, we have gone from whole-cell pertussis vaccines to acellular pertussis vaccines. That switch meant fewer side effects, but it also means the immunity offered by a vaccine doesn’t last as long or challenge the immune system as much.
Also, we see a larger proportion of children not being vaccinated because their parents refuse or delay vaccinations. That’s a big public health problem, it’s a community problem, and it’s a growing problem.
The message I want to get across is first: The vaccine is very safe. It may not work perfectly . . . but it will protect you from severe pertussis. It will protect your young children. It will protect you as an adult. It will protect teenaged children who are at schools.
I think it is important for families to know that adults should be vaccinated as well. There is a Tdap vaccine, which is now recommended for adults. Every adult should receive one dose of Tdap vaccine, and all pregnant women should receive a dose of Tdap vaccine for every pregnancy. We know that’s not happening. We recommend vaccinating pregnant women to help protect the babies from this serious infection until they can be vaccinated. Maternal immunization is the only tool we have to protect the very young. And it’s the very young who have the most serious disease.
FT: Since the early symptoms of pertussis are similar to other illnesses that are potentially dangerous to infants—RSV (respiratory syncytial virus), pneumonia—what guidelines should parents use in deciding when to act?
JS: Generally, if your baby is less than 2 months of age I would advise that parents always call the doctor when there are symptoms. They don’t always need to go to the doctor, but please call and ask.
Maybe through reading this, a parent can be an advocate for their child. It could be just a cold, or flu, but (asking) “Could my baby have pertussis?” can alert the provider to think about it, because early recognition and treatment may help the baby—the sooner the better. RSV is far more common, so the provider will have to weigh if they want to test for pertussis, after assessing the child’s risk of exposure.
We talk about the dangers for babies, but even for teenagers, pertussis can be very disruptive. They stay out of sports; it leaves you really, really tired. The coughing at night can interfere with sleep. It is a really debilitating disease.
In infants, it’s heartbreaking, because they cough until they turn blue. They cannot eat and they lose weight, they often need feeding tubes. They are so exhausted. The attacks are so violent that some babies pass out. Some babies actually present with apnea; they stop breathing. We do teach providers that if you have a young baby who presents with apnea, you need to think of pertussis. At that young age, apnea may be the only manifestation of the disease. So, I think a key message for your readers is: Pertussis is not a mild disease. It can be very serious.
FT: What do you recommend for parents of an infant in terms of reducing their exposure to unimmunized adults?
JS: The best way parents can protect their baby depends on the setting. Minimize the contact with ill relatives and friends. Encourage your relatives and friends—even before the baby is born—to get vaccinated for pertussis with the Tdap vaccine.
If the child has to be in a day care, licensed day care providers require immunization. I would encourage parents to check, when they are looking for day care for their child, to see whether that particular day care has children who are vaccinated. If not, I would strongly reconsider placement of a young baby in that day care setting, because of the risk for not only pertussis, but other infections as well. So, check with your day care: Are they licensed? Are the children vaccinated? Is the staff vaccinated?
FT: Can pertussis lead to more serious lung conditions?
JS: Yes. Pertussis can cause pneumonia, rib fractures. It can cause death in babies who stop breathing. It can cause brain damage when the coughing spells are so forceful. For babies who don’t have the kind of medical support we have in the United States, they can die of starvation. Essentially, they cannot get enough nutrition. Dehydration is a factor as well. I can tell you that babies most commonly stay in the hospital for pertussis for nutritional support, not oxygen. They need nutrition because they cough so much that they cannot eat.
FT: It seems that there is good communication from school districts in alerting parents to cases in the schools.
JS: Absolutely. I love the schools and the work they do to enforce vaccination. They alert parents to cases of pertussis in the school system, the (county) health department will communicate with residents once there is a community outbreak. Each plays a different role in terms of what to disclose. I think we have a pretty good system in our area and in our state, for early dissemination of information if there is an outbreak. The same applies to any communicable disease in a school setting.
Parents of young children who are not in school learn about it through the media. Once a school reports a case, the media usually catches on very quickly. Last year we had cases in Baldwinsville, and in Mannsville, and the media reported very quickly. That raises awareness. Parents no longer have to think about some of these diseases—measles, pertussis, H-flu, meningitis—because they no longer see them. So we need to remind parents that they still occur.
Schools report, and it’s public. What we see in the hospital, we don’t make public. I saw tetanus last year, I saw pertussis last year, and those cases were not reported. Those diseases occur much more frequently than parents perceive. That is key to the rise of parents’ refusal of vaccinations; they don’t see these as serious threats. They don’t know how serious they are because we (have been) so successful in either eliminating them or decreasing their incidences.
As a doctor, I will take any other infection over measles or pertussis—pertussis especially. It’s just so painful to watch. Once you treat a child with pertussis, it really breaks you and it really is painful when you know a child got pertussis because the parent did not vaccinate. I had several patients just last year, children who were not vaccinated—intentionally not vaccinated. So, I’d like parents to be aware that pertussis is out there, it’s really dangerous and you can be exposed and not know about it. It could be the lady next to you at the store who is coughing. That’s all it takes.