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A Guide to Pertussis

(“Whooping Cough”)

General Information:

   Pertussis is spread from person to person as a cough, similar to how a head cold is spread.  A typical case has three stages. It starts as a mild “head cold” appearing illness. Mild fever, congestion and mild cough are the common symptoms.

   The second stage is severe coughing. Continuous coughs that are so harsh and strenuous that there’s a “whoop” sound when the child breaths in. Coughing is so violent that vomiting is common and fevers are usually lowgrade (Below 100.5).

   Finally the last stage is a convalescent stage where symptoms very slowly fade out. This can last 6-10 weeks.

   Infants below 6 months of age usually have variations in the illness. Some can have no whoop, minimal cough and higher fevers. Others can have apnea or seizures.

   At least 6 other bacteria can cause a “whooping cough” like illness. The true version is caused by a bacteria called “Bordetella Pertussis” 

Spread of Illness:

   As many as 90% of unimmunized children may contract the illness if it’s in the community. Teenagers and adults now account for almost half of the cases as their immunity may not be complete.  24% of cases in one study were infants under 6 months of age. Incubation period is 6 to 20 days, usually 7-10 days.

Testing for Illness:

   The bacteria can be cultured but requires special cultures to grow. The best time for a culture of the nose and throat is in the first half of the illness. Many patients with Pertussis will have negative cultures. Some labs can run antibody tests for the bacteria and are suggestive of illness but not always accurate either. White blood cell counts are often elevated with lots of lymphocytes, but other illnesses can also cause the same results. Most of the time Doctors may start treating patients based on “Typical” clinical findings and use lab reports as confirmation of the illness.

Treatment:

    In the past family members, close prolonged contacts (ie day care workers and fellow daycare infants/children) and High risk personnel (Hospital contacts) have been treated. Treatment is usually done with erythromycin as a first choice; limited use of Biaxin and zithromax in adults has been shown successful. Treatment has to be done for 10-14 days.

Prevention:

   The best prevention is immunization with the DTaP immunization. The “aP” part of the immunization trio is for pertussis. Infants routinely receive this vaccination at 2,4,6 months and as a booster after a year of age. A total of five vaccinations with Pertussis are normally given by age five years.

   A few children with histories of neurologic problems need individual evaluation before giving the pertussis vaccination. Some neurologic disorders may disqualify infants and children from receiving the vaccine.  

This information was taken from the 25^th edition of the American Academy of Pediatrics “Red Book” or Report of the Committee on Infectious Diseases pages 435 to 448. Ask us for more detailed information on this serious illness.

Kent Kleppinger, MD

Laramie Pediatrics, pc

1252 North 22nd Street, Suite A

Laramie, Wyoming 82072

(307) 745-3704

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Send mail to Klep@Laramiekids.com with questions or comments about this web site.