Whooping Cough is Back

Whooping cough, also known as the 100 day cough, is caused by a bacteria, Bordetella Pertussis.  Once nearly vanquished, Pertussis  is again a public health problem in the US.  The cough is severe and uncontrollable with a distinct sound.  For adults it is a protracted annoyance but for children it may be deadly.  The CDC estimates that worldwide there are 16 million pertussis cases and about 195,000 pertussis deaths in children annually.  In the US there are now at least 50,000 cases/year.

For decades Pertussis was largely not an issue in the US thanks to the DTP vaccine which contained whole pertussis bacteria.  It often caused high fevers and seizures and parents also believed it caused brain damage although that was never proven.  Some parents successfully sued vaccine manufacturers who then abandoned the product.  This led to a “safer” alternative TdaP (acellular Pertussis) which indeed does not trigger severe reactions.  Years after the product came to market it became apparent that TdaP is solidly effective only in the first year and that after that immunity wanes.  Even more troubling is that TdaP is not protective against a newer Pertussis strain recently isolated from hospitalized children in the US.  Researchers are working on a better vaccine but it will take years to bring it to market but for now the vaccine is about  80-90% effective.

When is it especially important to get vaccinated?  If you’re pregnant or someone in your family is or you are around young children, especially young infants.  Infant mortality due to pertussis is significantly higher in infants under 2 months of age.

Pertussis should be treated with antibiotics in the first 3 weeks of onset.  That is when the condition is most likely to be spread to others.  The challenge is that the characteristic fits of coughing often do not appear until the 3rd week so it may not be easy to diagnosis.

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