Increasing whooping cough….

There was a report out yesterday that the cases of whooping cough (Bordetella pertussis) in Minnesota have doubled from last month and by May, have exceeded all cases reported there last year. There have been 700 cases so far this year, as compared to 97 cases in all of 2010.

Another report detailing the death of a child from a pertussis  describes how the disease acts: first cold-like symptoms and a fever. But the dangerous symptoms don’t occur with the fever, it is after the bacteria are gone, when they have done their damage that the real problem can start: severe uncontrollable coughing,  or whooping cough (click on this link to HEAR what whooping cough sounds like).  This is because during the actual infection, the bacteria have produced toxins that slowly kills the ciliated epithelial cells of the respiratory tract (which is vital to move mucous up and out of your respiratory tract).

Then the toxins the bacteria produce also cause an increase in mucous production. The immune system clears the bacteria but the double whammy the bacteria produced during the infection are already in play: the cilia are gone and mucous is increasing. The child has no way to clear the mucous out of their airways except by coughing. If the mucous isn’t moved, air cannot oxygenate the tissues and the need to cough increases. Children under a year are most at risk for death from infection. Then realize that this cough can last for up to six weeks or longer. The articles are calling it the “100 day cough”. The results? From the CDC:

In infants younger than 12 months of age who get pertussis, more than half must be hospitalized. Hospitalization is most common in infants younger than 6 months of age. Of those infants who are hospitalized with pertussis approximately:

  • 50% will have apnea
  • 20% get pneumonia
  • 1% will have seizures
  • 1% will die
  • 0.3% will have encephalopathy (as a result of hypoxia from coughing or possibly from toxin)

Of those infants younger than 12 months of age who die:

  • Refractory pulmonary hypertension is a common, severe complication that contributes to death
  • Encephalopathy occurs in approximately 20% of cases

Other complications can include anorexia, dehydration, difficulty sleeping, epistaxis, hernias, otitis media, and urinary incontinence. More severe complications can include pneumothorax, rectal prolapse, and subdural hematomas.

Adults who have an infection with Bordetella pertussis may have something as mild as a sore throat. But their ability to spread the bacteria to infants and children remain. There was a report out in Florida where an adult spread the infection to six unvaccinated children in his family, then they spread it to seven other families in the area.

No one is sure why we are seeing increasing pertussis, there are a lot of possible explainations, but one thing is known. If you are an adult, you need a booster shot to protect infants and children you could expose to the disease.  If your children haven’t been vaccinated, or are due for a booster, get them their shots (TDaP/DTaP)

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