An alarming rise in the number of whooping cough cases – also called pertussis – has medical experts urging parents to get vaccinations up to date.
Sandra McKay, M.D., a pediatrician with SSM Cardinal Glennon Children’s Medical Center and professor at Saint Louis University, notes that whooping cough cases among children have risen each year over about the last decade – now about 25,000 cases nationally.
This year in St. Louis County, about 60 cases have been reported, with 11 cases seen at Glennon Children’s Medical Center. Some of the most tragic reports have come from California, where there have been at least 15 deaths.
Dr. McKay notes that pertussis was a major childhood disease in past generations. In the 1930s before vaccinations were available, more than 250,000 cases occurred annually, with thousands of deaths.
Cases had diminished by the early 1990s to fewer than 1,000 per year and almost no deaths, but the incidence has steadily climbed. Many medical experts say this likely is in response to some parents choosing to forgo or delay vaccinations, creating a pool of unprotected children.
Dr. McKay explains that pertussis is a common bacteria that is always present in the population. Adults who are vaccinated as children have waning immunity and can contract mild disease.
When infants and young children who are not vaccinated become infected with the bacteria – either from carrier adults or from other children – their small lungs mount a massive immune response, producing copious amounts of mucus that they are unable to expel.
Children with full-blown infection try to cough up the mucus to clear the small airways, but unlike adults, are not able to produce a robust cough. Kids can cough so hard that they can need emergency care.
“It’s terrible to watch the children because they cough, cough, cough to the point where they turn blue,” Dr. McKay says. She adds that as kids with the infection try to cough hard to try to expel mucous, they gasp or “whoop” for air, giving the disease its common name.
“They cough so hard they can break blood vessels in their eyes and sometimes throw up. Adults can have a prolonged cough, but not the whoop and their symptoms are not nearly as severe.”
Dr. McKay cites sobering statistics: Among children who are hospitalized, 50 percent will have apnea, which is a medical term for briefly stopping breathing and requires emergency care; about 20 percent develop pneumonia; and 1 percent of hospitalized children die from pertussis.
Hospitalization typically lasts several weeks, and after their discharge, children often continue to have a persistent cough.
Fortunately, immunizations for whooping cough can protect children. The vaccine is given starting at two months of age, with a series of booster shots. Dr. McKay explains that the worst-case scenario for children who have begun the regimen of shots is to contract a mild form of the disease.
Once the vaccinations are completed, children are fully protected until at least adolescence, when protection can wane.
The formulation of the vaccine protects against other diseases too. The vaccine given to children is called “DTaP” or diphtheria, tetanus and pertussis.
Children get five doses of DTaP, one dose at each of the following ages: 2, 4, 6 and 15-18 months and 4-6 years
Adolescents should receive a booster at 11 or 12 years of age -- a requirement in many schools.
Adults also should receive a booster if it’s been at least 10 years since their last immunization for pertussis, particularly if they are parents or caregivers of young children and might transmit disease to an unvaccinated child.
The recommended booster vaccine for adolescents at 11 or 12 years of age and for adults, ages 19 to 64 and once every 10 years, is combined with the tetanus-diphtheria vaccine, and is called “Tdap” – tetanus, diphtheria and pertussis.
Dr. McKay urges parents to get immunizations up to date, especially for infants and small children. “We know that pertussis is present in the community,” she says. “We know how it affects children, how it affects babies; and we can prevent it.”
In addition to getting infants and toddlers up to date, she emphasizes the importance for adolescents and some adults to receive booster shots. “If you have a baby in the home, everyone in the home should be vaccinated against pertussis.”
Additional precautions should be taken for infants under two months that have not yet begun the immunizations. Dr. McKay says to keep infants at this age out of crowds where they might be exposed to an adult or child carrier of the infection. Limiting their exposure also can help protect infants against cold and flu viruses, she adds
Dr. McKay suggests that parents talk with their pediatricians or family physicians about any questions. She emphasizes not delaying because the pertussis bacteria is out there, and can rapidly infect groups of unvaccinated children.
“It can spread like wildfire among unvaccinated children, who can end up needing to be hospitalized, sometimes in intensive care,” Dr. McKay adds.