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: Whooping Cough Is Back
DEAR DR.PAUL: My 14 year old son was told that some children had whooping cough at his school. I thought children where vaccinated and that whooping cough was something that was seen only in the past. Why is it happening now?
DR.PAUL ANSWERS: Infants and young children are routinely vaccinated against whooping cough, or "Pertussis". However we are seeing more cases of whooping cough in teenagers because the vaccine seems to wearing off at this age.
Whooping cough is caused by a bacterium called Bordetella Pertussis which is spread through the air when an infected person coughs. Whooping cough tends to spread more easily in "close-contact" situations such as among family members and in schools. The infection begins like a regular cold that lasts for about a week and then the very characteristic cough phase develops. The cough occurs in spurts during which a child's face turns red, has teary eyes and often vomits after the cough. There is very characteristic"Whoop sound" during the cough giving the very scary impression of choking. This cough phase can last for up to 3 months and typically slowly goes away on its own. It can occur during any time of the day and usually is triggered by exercise. Although it causes great discomfort, Pertussis is not considered life threatening in older children and adults. However it can be very dangerous, even deadly in infants and young babies.
Confirming Pertussis is often not easy. Sometimes the diagnosis can be made by a nasal swab test. However, even if the test is negative it does not rule out whooping cough. In most cases the diagnoses is made based on the presence of the very characteristic cough episodes.
What about treatment? Unfortunately antibiotics do not usually change the duration of the symptoms. Antibiotics are generally given to the individual and close contacts to stop the spread of the bacteria. The only available treatment is supportive including cough medicines (given only under the direct supervision of a physician). Of course, babies with whooping cough are hospitalized for very close monitoring, treatment and support.
How is whooping cough prevented? The Pertussis vaccine has been very helpful in preventing whooping cough over the last several decades. However the older Pertussis vaccine was not 100% effective wore off with age and had some potentially serious side effects. It was initially given 5 times, incorporated with the routine vaccines schedule with the last booster given between 4-6 years of age. A newer version has been developed, known as the Acellular Pertussis vaccine, which is now recommended to be given 6 times including a last dose (combined with the diphtheria-tetanus vaccine) during the teenage years. The vaccine is quite safe but should not be given to children with a previous allergic reaction to the Pertussis vaccine or any element in the combined diphtheria-tetanus vaccine.
To conclude, whooping cough is still around. Administering a dose of the Acellular Pertussis vaccine to teenagers may surely help prevent it in this age group. I urge parents to talk to their doctor about the 6th dose of the whooping cough vaccine for their adolescents.
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