Whooping Cough Health Article

Allopathic treatment

Treatment with the antibiotic erythromycin is clearly helpful only in the very early stages of whooping cough, during incubation and early in the catarrhal stage. In general, however, physicians have used this antibiotic both for treatment of whooping cough itself and to prevent its spread to others in the patient's community. This type of preventive measure is known as prophylaxis.

Unfortunately, the benefits of antibiotic prophylaxis and treatment for whooping cough are limited because erythromycin-resistant strains of B. pertussis have spread throughout the United States since the first case of erythromycin resistance was identified in Arizona in 1994. Although erythromycin is still used as of 2003 for both treatment and prophylaxis of whooping cough, the Centers for Disease Control (CDC) is monitoring the five resistant strains of B. pertussis that have been identified so far.

Expected results

Just under 1% of all cases of whooping cough cause death; in 2000, only two deaths from whooping cough were reported in the United States. Children who die of whooping cough usually have one or more of the following three conditions:

• Severe pneumonia, perhaps with accompanying encephalopathy.
• Extreme weight loss, weakness, and metabolic abnormalities due to persistent vomiting during paroxysms of coughing.
• Other preexisting conditions, so that the patient 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 the immunization program. In the United States, inoculations begin at two months of age. The pertussis vaccine, most often given as one immunization together with diphtheria and tetanus (called DTP), has greatly reduced the incidence of whooping cough. With one shot backed with a 70% immunization rate, two shots increase it to 75–80%, and three to only 85%, it is not a guarantee.

A new formulation of the pertussis vaccine is available. Unlike DTP, which is composed of dead bacterial cells, the newer acellular pertussis vaccine is made up of two to five chemical components of the B. pertussis bacteria. The acellular pertussis vaccine (called DTaP; when combined with diphtheria and tetanus vaccines) greatly reduces the risk of unpleasant reactions, including high fever and discomfort at the injection site.

Because adults are the primary source of infection for children, there has been some talk in the medical community about vaccinating or giving booster vaccinations to adults. A recent increase of pertussis cases among adults in France has led several French medical schools to recommend booster doses of vaccine for adults.

BOOKS

Fetrow, Charles W. The Complete Guide to Herbal Medicines. Springhouse, PA: Springhouse Corporation, 1999.

Lockie, Andrew and Nicola Geddes. The Women's Guide to Homeopathy. New York: St. Martin's Press, 1994.

Pertussis in Adults: Epidemiology, Signs, Symptoms, and Implications for Vaccination, edited by Sydney M. Finegold, et al. Chicago: The University of Chicago Press, 1999.

Ryan, Kenneth J., and Stanley Falkour. "Pertussis." In Sherris Medical Microbiology: An Introduction to Infectious Diseases. edited by Kenneth J. Ryan. Norwalk, CT: Appleton and Lange, 1994.

Stoffman, Phyllis. The Family Guide to Preventing and Treating 100 Infectious Diseases. New York: John Wiley and Sons, Inc., 1995.

Ying, Zhou Zhong and Jin Hui De. "Whooping Cough." In Clinical Manual of Chinese Herbal Medicine and Acupuncture. New York: Churchill Livingstone, 1997.

PERIODICALS

Decker, Michael D. and Kathryn M. Edwards. "Acellular Pertussis Vaccines." Pediatric Clinics of North America 47 (April 2000): 309-335.

Gilberg, S., E. Njamkepo, I. P. Du Chatelet, et al. "Evidence of Bordetella pertussis Infection in Adults Presenting with Persistent Cough in a French Area with Very High Whole-Cell Vaccine Coverage." Journal of Infectious Diseases 186 (August 2002): 415-418.

Henderson, C.W. "Disease Still Potentially Deadly." World Disease Weekly (11/29/99-12/6/99): 17+.

Jenkinson, Douglas. "Natural Course of 500 Consecutive Cases of Whooping Cough: A General Practice Population Study." British Medical Journal 310 (6975)(February 4, 1995): 299+.

Laliberte, Richard. "The Threat of Whooping Cough." Parents 74 (January 1999): 45+.

"Pertussis Deaths—United States, 2000." Morbidity and Mortality Weekly Report 51 (July 19, 2002): 616-618.

Qin, X., D. K. Turgeon, B. P. Ingersoll, et al. "Bordetella pertussis PCR: Simultaneous Targeting of Signature Sequences." Diagnostic Microbiology and Infectious Disease 43 (August 2002): 269-275.

Wilson, K. E., P. K. Cassiday, T. Popovic, and G. N. Sanden. "Bordetella pertussis Isolates with a Heterogeneous Phenotype for Erythromycin Resistance." Journal of Clinical Microbiology 40 (August 2002): 2942-2944.

ORGANIZATIONS

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007. (847) 434-4000. <www.aap.org>

Centers for Disease Control and Prevention (CDC). 1600 Clifton Road, Atlanta, GA 30333. (404) 639-3311. <www.cdc.gov>.

Food and Drug Administration (FDA), Center for Biologics Evaluation and Research (CBER), 1401 Rockville Pike, Suite 200-N, Rockville, MD 20852. <www.fda.gov/cber>.

Belinda Rowland

Rebecca J. Frey, PhD