Let's Learn About Whooping Cough

Cough, cough, cough, cough, cough……….beep, beep, beep.

This was a common sound heard on the inpatient floor this past year as I worked as a hospitalist. Young babies coughing until they couldn’t catch their breath followed by our respiratory monitors alarming for low oxygen saturations and low heart rate. Unfortunately, it was so common I could diagnose the problem from the hallway. If you watch the news often you’ve probably guessed the diagnosis.

Pertussis. Also commonly referred to as whooping cough or, ”the 100 day cough”.

Tarrant County has seen many cases of whooping cough in the past several years:

• 2013 - 700 cases
• 2014 - 467 cases
• 2015 - 308 cases

Recently there was a case in the news media about an infant death from pertussis; unfortunately this happens to between 0.5-1 percent of children under a year who contract this illness.

Pertussis is primarily a respiratory infection caused by the bacteria Bordetella pertussis. It is very contagious! It is a tricky diagnosis to make because the initial 1-2 weeks of infection seem like a cold. Patients have a clear runny nose, sore throat, watery eyes with mild cough and may not even run a fever. These symptoms are usually treated symptomatically at home. When they fail to resolve and become more severe with the characteristic coughing spells they come to medical attention.

To diagnose pertussis a nasal/throat swab (similar to a flu test) has to be obtained. Unfortunately, the diagnosis usually isn’t made until this second phase of illness and treating with antibiotics at this point doesn’t do much to alter the course of the infection. The cough is frequently followed by a “whooping sound” as the patient struggles to catch their breath. Infants don’t tend to make this sound as often as older children. It is common to vomit after these long coughing episodes and this phase of illness lasts for at least a month. A month!

In younger babies (less than 4 months) it is common for them to cough until they are blue and to stop breathing (apnea) and to not be able to maintain adequate hydration or weight gain. Young infants with pertussis frequently require hospitalization. While working as a hospitalist, it was not uncommon for a baby to be in the hospital for a few weeks while we gave them intravenous fluids to keep them hydrated, fed them through a nasal feeding tube and supported them during coughing fits.

Unfortunately, this infection can be fatal and frequently babies do require mechanical ventilation (breathing machine) in the intensive care unit. Less commonly, the infection can cause brain swelling (encephalopathy) and cause seizures.

Pertussis is spread through respiratory droplets. Babies, who are at highest risk of severe complications and too young for vaccination, usually catch the infection from an adult who is undiagnosed. Patients are contagious for a long time, up to several weeks. Often, it is an older family member with a cough for several weeks duration. It is devastating to families when they realize they were unknowingly the source of the infection that has caused the baby to be hospitalized.

All pregnant women are now encouraged to receive a pertussis vaccine in the third trimester of their pregnancy along with the other adults that will be living in the home. Having this “cocoon” of protection helps protect vulnerable infants until they are old enough to receive the immunization themselves.