Whooping Cough Health Article

When to call the doctor

A physician or other healthcare professional should be contacted during the first two months of life to arrange for immunization. Otherwise, a person with a cough that lasts for more than a few days should be seen by a healthcare professional.

Diagnosis

A diagnosis that is based solely on a person's symptoms is not particularly accurate, as the catarrhal stage may appear to be a heavy cold, a case of the flu, or a case of bronchitis. Other viruses and tuberculosis infections can cause symptoms similar to those found during the paroxysmal stage. The presence of a pertussis-like cough along with an increase of certain specific white blood cells (lymphocytes) is suggestive of pertussis (whooping cough). However, cough can occur from other pertussis-like viruses. The most accurate method of diagnosis is to culture (grow on a laboratory plate) the organisms obtained from swabbing mucus out of the nasopharynx (the breathing tube continuous with the nose). B. pertussis can then be identified by examining the culture under a microscope.

Treatment

Treatment with the antibiotic erythromycin is helpful only at very early stages of whooping cough, during incubation and early in the catarrhal stage. After the cilia and the cells bearing those cilia, are damaged, the process cannot be reversed. Such a person experiences the full progression of whooping cough symptoms; symptoms only improve when the old, damaged lining cells of the respiratory tract are replaced over time with new, healthy, cilia-bearing cells. However, treatment with erythromycin is still recommended, to decrease the likelihood of B. pertussis spreading. In fact, all members of the household in which an individual with whooping cough lives should be treated with erythromycin to prevent the spread of B. pertussis throughout the community. The only other treatment is supportive and involves careful monitoring of fluids to prevent dehydration, rest in a quiet, dark room to decrease paroxysms, and suctioning of mucus from the lungs.

Prognosis

Just under 1 percent of all cases of whooping cough in the United States result in death. Children who die of whooping cough usually have one or more of the following three conditions present:

• severe pneumonia, perhaps with accompanying encephalopathy
• extreme weight loss, weakness, and metabolic abnormalities due to persistent vomiting during paroxysms of coughing
• other pre-existing conditions, so that the person is already in a relatively weak, vulnerable state (such conditions may include low birth weight babies, poor nutrition, infection with the measles virus, presence of other respiratory or gastrointestinal infections or diseases)

Prevention

The mainstay of prevention lies in programs similar to the mass immunization program in the United States that begins immunization inoculations when infants are two months old. The pertussis vaccine, most often given as one immunization together with diphtheria and tetanus, has greatly reduced the incidence of whooping cough. Three injections (a primary and two booster shots) during early infancy confer complete immunity. Unfortunately, in the 1990s, there has been some concern about serious neurologic side effects from the vaccine itself. This concern led significant numbers of parents in England, Japan, and Sweden to avoid immunizing their children. Such actions led to major epidemics of the disease in those countries. However, several carefully constructed research studies disproved the idea that the pertussis vaccine is the cause of neurologic damage. Furthermore, a subsequent formulation of the pertussis vaccine became available. Unlike the former whole cell pertussis vaccine, which was composed of the entire bacterial cell that has been deactivated (and therefore unable to cause infection), the subsequent acellular pertussis vaccine does not use a whole cell of the bacteria but is comprised of between two and five chemical components of the B. pertussis bacteria. The acellular pertussis vaccine appears to greatly reduce the risk of unpleasant reactions to the vaccine, including high fever and discomfort following vaccination.

Nutritional concerns

Persons with whooping cough should be given adequate nutrition to assist their bodies in recovering from the infective agent.

Parental concerns

Parents should ensure that their children receive a complete series of immunizations (three injections) against whooping cough. Children who are suspected of having whooping cough should be seen by a healthcare professional. Early treatment is essential to limit the progression of the disease.