Is Whooping Cough Only a Baby's Disease
by Sandra Gardner, RN
In the past year there have been reports of whooping cough outbreaks in middle and junior high schools. So what is whooping cough? Whooping cough, also called pertussis, is an illness caused by a bacteria called Bordetella pertussis.
It usually begins with symptoms much like the common cold: low-grade fever, runny nose, and cough. This progresses into the second stage, which is characterized by sudden attacks of forceful coughing. At the end of each coughing episode, a long inspiratory effort is made to get air into the lungs which is accompanied by a 'whoop' sound. Vomiting may also occur. This stage may last up to ten weeks. The third stage, recovery, may take up to six weeks or longer, during which time the cough disappears.
Whooping cough is highly contagious and is transmitted person to person by inhaling droplets coughed or sneezed into the air by an infected person. If antibiotic therapy is given during the coughing stage, it is only to limit the spread of the disease. In order for the drug therapy to get rid of the illness, it must be given during the first stage of the illness. Because of the high communicability of whooping cough, antibiotic prophylaxis should be administered to all household contacts and other close contacts of the infected person.
Sixty years ago, whooping cough was one of the most common diseases in children. Then, in the 1940s, when the first vaccine became available, the incidence of this dreaded disease decreased by more than 98%, and we had all but forgotten about it.
In the last three decades, however, there has been a gradual rise in the number of reported cases. According to data from the Centers for Disease Control and Prevention, in Atlanta, roughly 20,000 cases were reported in 2004 alone. Thirty-eight percent of all these reported cases were in children 10-19 years of age.
But these numbers are somewhat deceiving because classic symptoms of the disease are not always present in older children and may go unreported. A 2005 study published in the New England Journal of Medicine reported that between 13% and 32% of older children and adults with a cough illness of six days or longer would show evidence of whooping cough in laboratory findings.
So what is responsible for these disturbing statistics? Most children receive a series of whooping cough vaccines with a booster around age five. It is now thought that immunity decreases after five years when these children are older, leaving them susceptible.These individuals may unknowingly pass the disease on to vulnerable infants and younger children.
Prior to 1999, there were no booster vaccines available to anyone older than seven years of age. Between 1999 and 2005, booster vaccines were licensed for persons older than seven years outside the United States. On May 3, 2005, the United States Food and Drug Administration approved the first combination vaccine for use in the U.S. It is pertussis combined with tetanus and diphtheria (Td) and is indicated for children 10-18 years. The new vaccine is called Boostrix (Tdap) and is manufactured by GlaxoSmithKline Biologicals (GSK). It can be given as a five-year single dose booster for the series given in childhood. According to Dr. Leonard Friedland, a vaccine research physician at GSK, the goal with the Tdap is to protect those who receive it against tetanus, diphtheria, and pertussis. It is a response to a public health need of getting control of pertussis.
The Advisory Committee on Immunization Practices (ACIP), a group of immunization experts appointed by the secretary of the U.S. Department of Health and Human Services, has formally recommended that Tdap vaccine be given to children ages 11-18 in place of the Td that is currently given.
There is now a way to prevent this devastating disease in infants, older children, and adults. For more information on Tdap, contact your health care provider or visit the following websites:
