Pertussis: An Old Enemy Resurfaces

The Association for Professionals in Infection Control and Epidemiology (APIC) reminds healthcare professionals and healthcare consumers that pertussis, commonly known as whooping cough, is a serious respiratory illness characterized by an infectious cough. Although most of us were vaccinated against it as children, our ability to fight it off weakens, leaving us once again susceptible as adults. Pertussis is very contagious and can be quite serious, especially for infants less than one year of age.

Pertussis is recognized by uncontrollable, violent coughing that often makes it hard to breathe. After an episode of many coughs, someone with pertussis often needs to take a deep breath which results in a "whooping" sound. This disease most commonly affects infants and young children and can be fatal, especially in babies younger than one year of age.

To hear what the pertussis cough sounds like, visit the Centers for Disease Control and Prevention (CDC) site: http://cdc.gov/pertussis/

Why is there a concern now? There are many factors that may account for the rise in pertussis cases:

- Not all babies are getting the vaccinations to protect them.

- Protection against whooping cough from early childhood vaccination decreases over time, and teens and adults can become infected repeatedly.

- Pertussis rates among adults have risen 400 percent since 1990.

- Children, teens and adults with undiagnosed pertussis can spread the disease to others.

Recently the number of pertussis cases has risen significantly, particularly in California where in 2010, more than 7,800 cases were reported and 10 babies died. In New York state, a cluster of 35 cases occurred among children at a local summer camp, and the infection spread to parents and other family members. Similar outbreaks have occurred in other states.

How is pertussis spread?

Pertussis is a year-round disease that peaks in fall and winter during cold and flu season. Caused by a germ found in the mouth, nose and throat, it spreads when people with the illness cough or sneeze close to others who breathe in the droplets.

What are the signs and symptoms?

Pertussis usually starts with cold symptoms (runny nose, sneezing, mild fever and cough). This is called stage 1 and lasts for about two weeks. In stage 2, the coughing becomes more severe and frequent, and the "whooping" sound is heard. People with pertussis may have 15-24 coughing attacks a day. After an episode, the person often vomits and feels very tired. Between episodes, there may be no signs of illness. This stage can last for weeks or months, which is why pertussis is sometimes called the "100-day cough." Stage 3 lasts about 2-3 weeks, as the person gradually gets better with less and less coughing.

Common signs of whooping cough are:

- Severe coughing that sounds like a "whoop" as the patient gasps for breath

- A cough that brings up a thick mucus

- Skin that becomes a bluish color from lack of oxygen after a severe coughing episode

If you have been vaccinated, you can still get pertussis; however, the infection will be less severe. If you or your child develops a cold that includes a severe cough, or a cough that lasts for a long time, it may be pertussis. The best way to find out is to visit your doctor. If your doctor tells you that you have pertussis, your body will have a natural defense (immunity) against future infections. However, this immunity can fade and does not offer lifelong protection. You should get routine vaccinations as recommended.

Immunization

The best way to protect against pertussis is to get vaccinated. Adults should be immunized to protect children, especially babies. Getting vaccinated is especially important for families with and caregivers of new infants. Many infants are infected by older siblings, parents or caregivers who might not even know they have whooping cough. Babies are most vulnerable before they can have their first vaccine against pertussis at two months of age. Children are not fully protected until they have received the complete course of vaccination by age seven.

The CDC recommends a single pertussis booster for any adult aged 19 to 64 who is in close contact with a baby, particularly parents, grandparents, babysitters and healthcare workers who work with infants. Adults who didn't get the tetanus, diphtheria, and pertussis(Tdap) booster vaccine as a pre-teen or teen should get one dose of Tdap instead of their next regular tetanus and diphtheria(Td) booster vaccine. Most pregnant women who were not previously vaccinated with Tdap should get one dose of Tdap postpartum before leaving the hospital or birthing center. The CDC also recommends the Tdap booster vaccine to protect adolescents between the ages of 11 and 18.

Do healthcare providers play a role in the spread of pertussis?

Spread of pertussis has been documented in hospitals and other healthcare settings. In one outbreak, an infected healthcare provider (HCP) exposed 191 people, including co-workers and patients. Recent estimates suggest that up to nine HCPs are exposed on average for each case of pertussis with delayed diagnosis. All HCPs who have never received Tdap, or if it has been at least two years since the last dose of tetanus vaccine (although some experts suggest that a two-year interval is not necessary), should consider being vaccinated. HCPs who care for newborns or infants younger than 12 months, or those who work in Maternity or Emergency Departments, should receive Tdap.

Antibiotics

Your healthcare provider may recommend preventive antibiotics if you have been in close contact with a person with pertussis, regardless of your age or vaccination status. This might prevent or reduce the chance of getting this infection. A close contact is anyone who has had face-to-face contact or shared a small space for a long period of time with an infected person, or had direct contact with respiratory secretions (from coughing or sneezing) from an infected person.