It is back. Like scarlet fever, the name sent fear through our grandparent’s generation. California is in the midst of a whooping cough epidemic. For the very young, under three or four months of age, this can lead to severe illness and even death. Every three to five years, this infection tends to rear its ugly head. This has been all over the news recently and I am constantly on the lookout for possible cases. I know of cases where everything was done correctly and infants still passed away.

Pertussis is the organism that leads to whooping cough and the last round hit in 2005. It seemed like every other teenager was coming in with a severe cough. Many of the high schools had strict rules on what needed to be done if a student had any cough. We were asked by the Public Health Department and our infectious disease specialist to treat at the slightest suspicion of having pertussis. These suspected cases were not allowed to return to school until medicine was taken. Most teens do fine but it can be a very uncomfortable illness.

The P in the DTaP vaccine is for pertussis. It is a bacteria that can lead to a prolonged and sometimes severe cough. The Chinese call this the “100 Day Cough.” It usually starts as a mild cold. Looking like a typical virus, it often goes undiagnosed for a long time. The second stage is where the “whoop” potentially occurs. The classic “whoop” happens at the end of a prolonged fit of coughing.

Many children will turn blue in the face during a fit and after a pause take in a huge breath that results in a whooping sound. After the fits and whoops, many children will vomit. The recovery stage then follows with a chronic cough that improves over weeks to months. The whoops usually don’t happen with children less than three months of age. The first two stages typically last two to three weeks each. The last stage can last for months. A handful of children die every year in California from pertussis.

The vast majority are under three months of age. Most infants contract this from a family member. Typically children under the age of six months become most ill. Older children can fracture ribs while coughing. Between fits most children look perfect. Infected individuals can have a normal exam and chest x-ray. It is the history of the illness, exposure to others, and vaccine status that often leads to a diagnosis. Testing for pertussis is not very reliable and often we will treat even if the tests come back negative.

The biggest reservoir for pertussis is the late teen and adults who have not had a pertussis vaccine in many years. People are most contagious in the first two weeks of the illness when it looks like a common cold. By the time the severe fits and whoops show up, they are less contagious but can still spread the bacteria.

Unimmunized infants can spread the disease for six to eight weeks. Bacteria can even be found in the nose of patients after five days of antibiotics. Treating with antibiotics does NOT always shorten the illness. Treating infected people is used mainly to prevent the spread of the disease and protect the very young and the unimmunized.

It amazes me that parents choose not to vaccinate their children for this disease. Some will want to delay the vaccines until they are older. These vaccines are given to the young because it is the very young that typically die from pertussis. I have families that don’t vaccinate and I am always more concerned when they come in with an illness. Families that are planning on having a baby, have an infant, or are around infants should be vaccinated as well. We now give the pertussis vaccine to all adults when they receive their tetanus shots. If you or your teenager has not had a tetanus booster in the last few years, have it done soon. Protecting yourself could unknowingly save a child’s life.