general health
BY NORA HESTON TARTE
MORE Than a BAD COUGH THE 411 ON WHOOPING COUGH
tion (CDC) recommend that expectant mothers Every year 50-200 California infants are receive the whooping cough booster shot (also hospitalized with pertussis—also comcalled Tdap, or tetanus, diphtheria, and acellumonly referred to as whooping cough— lar pertussis vaccine) at the earliest opportunity and while that number isn’t high, it is certainly between 27 and 36 weeks of every pregnancy, even too many. Peak pertussis numbers hit around if previously immunized,” says Mamta Jain, chair 2012 with more than 48,000 cases of pertussis of the Department of Pediatrics at San Joaquin reported in the U.S., the highest number reportCounty Clinics. “Getting immunized during preged in more than 50 years. Case fatality rates are nancy boosts a mother’s immunity and passes on approximately 1 percent in infants younger than protective antibodtwo months and less ies directly to their than 0.5 percent in babies before birth. “No baby should have to be infants two through This helps protect eleven months of age. hospitalized due to a vaccinenewborns until they Getting a vaccine can prevent whoop- preventable disease, and certainly are old enough to begin receiving their ing cough and is no baby should die,” Dr. Jain, own whooping cough a huge part of the San Joaquin County Clinics immunizations at reason spread of the six to eight weeks of disease is typically age.” low, despite being highly contagious. As long After the first vaccine is given at two months old as people are vaccinated when they can be, (although it can be given as early as six weeks if whooping cough will not become an epidemic. needed), kids receive a booster in seventh grade Babies under two months of age are susceptiand adults receive a whooping cough booster once ble because they haven’t yet had the vaccine, in their lives unless otherwise requested and/or however, maternal vaccination can help. “Calirecommended. fornia Department of Public Health (CDPH) and So, there is a well thought out plan for limiting the Centers for Disease Control and Prevenspread of whooping cough, but that doesn’t change the fact that some infants in California will still contract the disease. Part of the struggle is knowing when to seek care and when a cough is more than just a cough. The symptoms vary by age. Most children will experience a runny nose and cough that lasts one to two weeks. Then, the cough ramps up and children experience rapid coughing spells punctuated by a telltale whooping sound at the end. Infants, however, may never experience a cough. “Parents may describe episodes in which breathing briefly stops and the infant’s face turns red or purple,” Dr. Jain says. For older children and adults, the illness typically presents itself as a cough that lasts for several weeks It is likely to start with mild upper respiratory tract symptoms similar to common cold and progress to a cough with a “whooping” or gasping sound at the end. It’s common for vomiting to follow the cough, as well. Symptoms may take weeks or even months to sub34
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2020 SJ HEALTH AND MEDICAL GUIDE
side, with an average sick time of six to ten weeks. “Approximately half of adolescents with pertussis cough for 10 weeks or longer,” Dr. Jain says. For many, whooping cough is an awful illness that they will recover from, but it can be dangerous especially for infants under six months of age. It is most dangerous in preterm and unimmunized infants. The stats are scary. Sixty-seven percent of infants will experience gagging, gasping, and/or apnea when they have whooping cough. Sudden death is also possible in infants. Complications among infants include pneumonia, pulmonary hypertension, and complications related to severe coughing spells such as conjunctival bleeding, hernia, severe coughing spells leading to hypoxia, and complications such as seizures, encephalopathy, apnea, and death. “More than two-thirds of infants with pertussis are hospitalized,” Dr. Jain says. Pertussis is highly contagious, as well, and even previously immunized people can contract the disease. This is in part due to how and when the vaccines are given. If you’re unsure, a test is available to check for the presence of antibodies in the bloodstream. If needed, additional boosters can be given. Limiting exposure to the general public as well as asking those who come in close contact with your baby to receive the booster, can help mitigate risk. You should also avoid people who are coughing, and if your child will be in daycare, ensure they have received the vaccine before enrollment.
