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Whooping Cough / Pertussis
Pertussis (also known as whooping cough or 100-day cough) is a highly contagious bacterial disease. Initially, symptoms are usually similar to those of the common cold with a runny nose, fever, and mild cough. This is then followed by weeks of severe coughing fits. Following a fit of coughing, a high-pitched whoop sound or gasp may occur as the person breathes in. The coughing may last for 10 or more weeks, hence the phrase "100-day cough". A person may cough so hard that they vomit, break ribs, or become very tired from the effort. Children less than one year old may have little or no cough and instead have periods where they do not breathe. The time between infection and the onset of symptoms is usually seven to ten days. Disease may occur in those who have been vaccinated, but symptoms are typically milder.
Pertussis is caused by the bacterium Bordetella pertussis. It is an airborne disease which spreads easily through the coughs and sneezes of an infected person. People are infectious to others from the start of symptoms until about three weeks into the coughing fits. Those treated with antibiotics are no longer infectious after five days. Diagnosis is by collecting a sample from the back of the nose and throat. This sample can then be tested by either culture or by polymerase chain reaction.
Prevention is mainly by vaccination with the pertussis vaccine. Initial immunization is recommended between six and eight weeks of age, with four doses to be given in the first two years of life. The vaccine becomes less effective over time, with additional doses often recommended for older children and adults. Antibiotics may be used to prevent the disease in those who have been exposed and are at risk of severe disease. In those with the disease, antibiotics are useful if started within three weeks of the initial symptoms, but otherwise have little effect in most people. In children less than one year old and among those who are pregnant, they are recommended within six weeks of symptom onset. Antibiotics used include erythromycin, azithromycin, clarithromycin, or trimethoprim/sulfamethoxazole. Evidence to support interventions, other than antibiotics, for the cough is poor. Many children less than a year of age require hospitalization.
An estimated 16.3 million people worldwide were infected in 2015. Most cases occur in the developing world, and people of all ages may be affected. In 2015, it resulted in 58,700 deaths – down from 138,000 deaths in 1990. Nearly 0.5% of infected children less than one year of age die. Outbreaks of the disease were first described in the 16th century. The bacterium that causes the infection was discovered in 1906. The pertussis vaccine became available in the 1940s.
Worldwide, whooping cough affects around 16 million people yearly. One estimate for 2013 stated it resulted in about 61,000 deaths – down from 138,000 deaths in 1990. Another estimated 195,000 child deaths yearly from the disease worldwide. This is despite generally high coverage with the DTP and DTaP vaccines. Pertussis is one of the leading causes of vaccine-preventable deaths worldwide. About 90% of all cases occur in developing countries.
Before vaccines, an average of 178,171 cases was reported in the U.S., with peaks reported every two to five years; more than 93% of reported cases occurred in children under 10 years of age. The actual incidence was likely much higher. After vaccinations were introduced in the 1940s, pertussis incidence fell dramatically to approximately 1,000 by 1976. Incidence rates have increased since 1980. In 2015, rates in the United States were 20,762 people.
Pertussis is the only vaccine-preventable disease that is associated with increasing deaths in the U.S. The number of deaths increased from four in 1996 to 17 in 2001, almost all of which were infants under one year. In The U.S. pertussis in adults has increased significantly since about 2004. In 2010 ten infants in California died, and health authorities declared an epidemic encompassing 9,120 cases. In April and May 2012 pertussis was declared to be at epidemic levels in Washington, with 3,308 cases. In December 2012 Vermont declared an epidemic of 522 cases. Wisconsin had the highest incidence rate, with 3,877 cases, although it did not make an official epidemic declaration.
In Canada, the number of pertussis infections has varied between 2,000 and 10,000 reported cases each year over the last ten years, and it is the most common vaccine-preventable illness in Toronto.
In 2009 Australia reported an average of 10,000 cases a year, and the number of cases had increased.
Worldwide, there are an estimated 16 million cases of pertussis and about 195,000 deaths per year. In 2012, the most recent peak year, 48,277 cases of pertussis were reported in the United States, but many more go undiagnosed and unreported. This is the largest number of cases reported in the United States since 1955 when 62,786 cases were reported. Since the 1980s, there has been an increase in the number of reported cases of pertussis in the United States. In 2010, an increase in reported cases among 7 through 10 year olds was seen. Similar trends occurred in the following years; however, an increase in cases was also observed among teens.
Three women were instrumental in developing the Whooping cough/pertussis vaccine:
- Grace Eldering (1900-1988)
- Loney Gordon (1915-1999)
- Pearl Kendrick (1890-1980)
Notable people who died from Whooping Cough:
For Additional Reading:
- Wikipedia - Pertussis
- CDC - Pertussis (Whooping Cough)
- WebMD - Whooping cough: Causes, Symptoms, & Treatment
- Mayo Clinic - Whooping cough
- The New York Times - For Pregnant Women, Getting Serious About Whooping Cough
- The New York Times - Why Pertussis Is Making a Comeback
- CDC Pertussis Outbreak Trends
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