Coughing to death

It’s difficult to diagnose. It’s potentially lethal, and it’s spreading. An infectious disease that, until the introduction of the vaccine, was once the leading cause of childhood illness and death during the first half of the 20th century, is back — and spreading across the nation with a vengeance.

Whooping cough is caused by the bacterium Bordetella pertussis (or B. pertussis). When an infected person coughs or sneezes, tiny germ-laden droplets are sprayed into the air and breathed into the lungs by anyone who happens to be nearby. Once inside a person’s airways, the bacteria multiply and produce toxins that interfere with the respiratory tract. The bacteria causes inflammation that narrows the breathing tubes in the lungs, causing uncontrollable coughing.

When a person becomes infected with whooping cough, it takes an estimated three to 12 days for signs and symptoms of the disease to appear. The symptoms are usually mild at first, and may resemble the symptoms of a common cold. They can include:

• Runny nose

• Nasal congestion

• Sneezing

• Red, watery eyes

• Mild fever

• Dry cough

After a week or two, the signs and symptoms will become worse. Severe and prolonged coughing attacks may cause extreme fatigue; a reddish or blue face from constant coughing; vomiting; a persistent hacking cough; or a high-pitched “whoop” sound during each breath of air (although many people — including infants, teenagers, and adults — do not always develop the characteristic whooping sound).

If diagnosed early, whooping cough can be treated with antibiotics. If left undiagnosed — especially in infants less than 6 months of age — complications from whooping cough are more severe, and can include “pneumonia, apnea, dehydration and failure to thrive,” according to Joan Bregstein, MD, attending physician in the Division of Pediatric Emergency Medicine at New York Presbyterian-Morgan Stanley Childrens Hospital.

Risks for pregnant women

Confirmed cases of whooping cough are most commonly diagnosed in adolescents and adults. They may not realize that what they think are cold-like symptoms is an infectious disease, and may pass it on to family members. But, if the person who is exposed to the bacteria is an unvaccinated pregnant woman or infant, whooping cough may initiate a multitude of medical complications to not only pose a threat to an expectant woman’s health, but to the health of her baby.

Due to the dangers of the illness towards both an expectant woman and her unborn baby, an advisory panel of members from the Centers for Disease Control and Prevention has recommended that all pregnant women be vaccinated against whooping cough during their second or third trimesters. A study published in the Sept. 26, 2011 edition of the medical journal Clinical Infectious Diseases reiterated the panel’s findings, since researchers also found that vaccination during pregnancy, rather than after giving birth, is more effective. Lead researcher Scott Halperin, MD, of Dalhousie University in Halifax, Nova Scotia, discovered that if the vaccine is received during a mother’s postpartum period, her body will not be protected against the bacteria for about two weeks. Her body could harbor the bacteria and unknowingly infect her infant during the most vulnerable time prior to the beginning of their first series of vaccinations.

“It is clear that protection during this two week postpartum period is critical, because of the one- to three-week incubation period of pertussis, and the frequency of deaths in infants up to six weeks of age,” says Halperin.

Potential link between avoiding vaccination and rise in outbreaks

Before a vaccine was available, whooping cough claimed the lives of between 5,000 and 10,000 people in the United States each year. The first vaccine was developed in the 1930s, and became widely used in the 1940s.

According to the March of Dimes, a new vaccine called Tdap was introduced in the early 1990s, and it currently works as well as the original vaccine, but has fewer side effects.

However, in the last two decades, there has been a steady increase in the number of parents who are avoiding vaccinating their children for a wide variety of beliefs. There are also parents who are concerned about the amount of vaccinations that young children receive, which they feel may be an indirect cause of autism, or they may want their children to avoid any possible side effects related to vaccinations.

Could the growing trend of vaccine refusals be the driving force behind last year’s whooping cough epidemic? In California, more than 5,270 infants were diagnosed with the disease, and nine of them died.

According to the California Department of Public Health, the rate of whooping cough cases in 2010 was the highest amount ever recorded in the state since 1955. Most of the cases that were diagnosed in 2010 occurred in areas where — due to a California state law — schools had the ability to exempt children from routine vaccination based upon families’ personal beliefs. As a direct result of the epidemic, California passed legislation requiring proof that all children entering middle and high schools have the Tdap vaccination.

Other states, however, have not followed California’s lead, and of those states, Florida, Illinois and Virginia are currently reporting a steady rise in the number of children in this age group diagnosed with whooping cough.

Docs cry poverty

There may be another element in play: the financial challenges of vaccinating patients. The results of a study published in the December 2008 edition of the medical journal Pediatrics are startling. Researchers surveyed 597 pediatricians and family physicians and discovered that 49 percent of those doctors practiced in an office that delayed purchasing a new vaccine due to financial concerns. Five percent of pediatricians and 21 percent of family physicians stated that in the last year, they seriously considered discontinuing the immunization of privately-insured patients because of the vaccine cost, as well as administration and payment issues.

In order to prevent another epidemic, it is crucial that accurate information about whooping cough become known to parents and caregivers everywhere.

Jennifer Lacey is a freelance journalist whose work has been featured in numerous parenting magazines throughout the country.