Wednesday, May 24, 2006

Is Whooping Cough Back?

Is Whooping Cough Back?
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Q: A friend of mine has whooping cough. He's an adult in his 40s. His doctor told him that there's a lot of whooping cough going around these days. How so? I was vaccinated against it as a child. Can I still get it? -- Kristoph A: Whooping cough seems to be making a comeback. According to the U.S. Centers for Disease Control almost 19,000 cases were reported last year, nearly twice those reported in 2003, and my own state of Arizona recently declared a statewide outbreak. Health authorities said that 295 cases had been confirmed in four counties (including that of a 19-month-old baby who died), but estimated that the number was artificially low since many adults and older children with the disease probably haven't been reported or treated. And an article in the May 17, 2005 issue of the Annals of Internal Medicine urged increased awareness of whooping cough among physicians because of the growing incidence among adults and adolescents.
Unfortunately, adolescents and young adults are at risk of the disease because they're no longer protected by the immunizations they had as young children. The vaccine typically lasts from five to 10 years so if you were immunized more than 10 years ago, you would no longer be protected unless you got a booster shot. In June (2005) the FDA approved a new vaccine, Adacel, to boost immunization against whooping cough, tetanus and diphtheria for adolescents and adults between the ages of 11 and 64. Earlier in the year, the FDA approved a similar vaccine (Boostrix) for use in adolescents from ten to 18 years of age.
Whooping cough is caused by a bacterium called Bordetella pertussis. The disease is highly contagious and is passed from person to person by direct contact with droplets from the coughing or sneezing of an infected person. The most contagious period is early in the disease when the only symptoms appear to be those of a common cold: runny nose, sneezing, conjunctivitis (or pink eye), an occasional cough, and a mild fever. After a week or two, the "cold" enters another stage with symptoms that characterize whooping cough: violent fits of coughing and a gasp for breath in between coughs that sounds like a "whoop." The coughing is so severe and deep that it often triggers vomiting and can result in broken ribs, pneumonia, seizures and dehydration. Attacks typically occur at night and can leave you exhausted from lack of sleep. In between coughing fits, you seem perfectly okay.
Unfortunately, whooping cough isn't easy to treat. If it is diagnosed during the first week, the antibiotic erythromycin may lessen the severity and duration of the infection. After that, there's no good treatment - you just have to let it run its course, which typically lasts six to eight weeks. Cough medicines usually don't help much. Over time, the coughing lessens in frequency and intensity but can linger for months. Household contacts should be immunized and also treated with erythromycin.
Secondary bacterial pneumonia can occur in up to 30-40 percent of patients. It is the most frequent complication and the most frequent cause of death. Pneumonia can also occur with pertussis, but it is most often caused by other invasive bacteria and should be aggressively treated with antibiotics.
Why is whooping cough coming back? Most likely because significant numbers of people stopped immunizing their kids out of concerns over the safety of pertussis vaccine. We now have a newer, safer vaccine, and there is no reason not to use it. The risks of pertussis are much greater than those of the vaccine. This disease is no joke: in 2004, there were 20 deaths in the United States from whooping cough, 19 of them among babies who hadn't been vaccinated or were too young to be vaccinated.
Andrew Weil, MD
Last Reviewed: June 2005

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