The Sounds of Pertussis

Why the Sounds of Pertussis Must be Silenced
Babies Are Most Vulnerable
Adult Immunization Protects Children
Immunizing Children for Full Protection
Recognizing Pertussis
The Way It Was
On the Rise
Avoid Contact With Others to Prevent Spread
How Vaccines Work

Pertussis, also known as whooping cough, is a potentially deadly bacterial infection that can strike at any age, but is particularly dangerous for babies. The sounds of pertussis are like no other, marked by a “whoop” made when gasping for breath after a severe coughing attack.

Why the Sounds of Pertussis Must be Silenced

Pertussis can be a serious illness, particularly for babies and young children. More than 50% of babies with reported cases of pertussis must be hospitalized. Coughing can be so severe that it is hard for babies to eat, drink or breathe.

• Babies may bleed behind the eyes and in the brain from coughing.
• The most common complication is bacterial pneumonia. About 1 child in 10 with pertussis also gets pneumonia, and about 1 in every 50 will have convulsions.
• Brain damage occurs in 1 out of every 250 children who get pertussis.
• Pertussis causes about 10-20 deaths each year in the United States.

Babies Are Most Vulnerable

Babies are at the highest risk for developing complications from pertussis and dying. Ninety percent of pertussis-associated deaths have been among babies younger than six months of age.

Parents are responsible for more than half of whooping cough cases in babies, when the source could be identified. It is easily spread because it is most contagious during the first few weeks of infection when symptoms may resemble a cold. A parent, grandparent or babysitter suffering from what seems like a cold can actually have pertussis and spread the disease to the baby.

Parents, caregivers and other family members should be vaccinated to help “cocoon” babies and young children when they are most vulnerable to the dangers of pertussis.

Adult Immunization Protects Children

One of the best ways to protect babies from pertussis is to make sure that anyone in close contact with them is vaccinated. Babies are most vulnerable before they can have their first vaccine against pertussis at two months of age. However, babies under six months are still very much at risk, and children are not fully protected until they have been vaccinated with the primary series.

The Centers for Disease Control and Prevention (CDC) recommend immunization for all adults and adolescents as the best way to prevent the spread of pertussis among young children before they can be fully vaccinated themselves. Because immunity from early childhood vaccination decreases over time, adults and teens can become infected with pertussis time and again.

• The CDC recommends a single pertussis booster for all adults aged 19 to 64, especially those in close contact with a baby, particularly parents, grandparents and babysitters. The pertussis booster vaccine is given in combination with the vaccines for diphtheria and tetanus in the vaccine called Tdap. The “P” in Tdap refers to pertussis.
• The CDC also recommends the Tdap booster vaccine to protect adolescents between the ages of 11 and 18.

Immunizing Children for Full Protection

During a pertussis outbreak, children who have received all of their pertussis vaccinations are six times less likely to become infected than those who have never been vaccinated.

• To be fully protected against pertussis, children need four doses of the DTaP vaccine by 15-18 months of age. It is important to follow the recommended schedule as babies are vulnerable to infection until fully vaccinated.
• Most children who are vaccinated with DTaP will be protected throughout childhood.

Recognizing Pertussis

People of any age can become infected with pertussis if they are not vaccinated. In fact, in 2005, two-thirds of pertussis cases were among adolescents and adults.

Pertussis is caused by a bacterium called Bordetella pertussis, found in the mouth, nose and throat. It is spread through droplets from the mouth and nose when an infected person coughs, sneezes or talks. Classic pertussis usually starts with cold symptoms (runny nose, sneezing, mild fever and cough). After about two weeks, the coughing becomes more and more severe. This stage can last for weeks and even months. It's aptly nicknamed the 100-day cough.

Common signs of a whooping cough episode include:

• severe coughing, followed by what sounds like a "whoop" as the patient gasps for breath
• a cough that brings up a thick mucus
• infants and children turn blue from lack of oxygen

Patients may have 15-24 coughing attacks a day. After an episode, the patient often vomits and feels very tired. Between episodes, there may be no signs of illness.

Mild pertussis is often mistaken for a cold or bronchitis. Studies have shown that teens and adults tend to have the disease in its milder form. Usually people with mild pertussis have a persistent cough without the whooping sound.

The Way It Was:

• Pertussis was first described in the 16th century.
• The bacteria causing pertussis was first isolated in 1906.
• Well into the 20th century, pertussis was one of the most common and dangerous childhood diseases.
• Before a pertussis vaccine was available in the 1940s, more than 200,000 cases were reported each year.
• In 1976, a record low of 1,010 cases were reported.  In 2004 the number rose to more than 25,000 cases.  Because pertussis often is misdiagnosed and unreported, the number of cases each year actually may be nearly one million.

On the Rise

Pertussis is the only infectious disease for which children are routinely immunized that is on the rise. After immunization was introduced in the 1940s, the number of pertussis cases dropped by almost 100 percent. However, the number of cases is rising. Often misdiagnosed as a cold, pertussis may be vastly underreported. In 2005, more than 25,000 cases were reported, but the number of annual cases may be much higher.

Many factors account for the rise:

• Not all babies are getting the vaccinations they need.
• Protection against whooping cough through early childhood vaccination decreases over time, and teens and adults can become infected repeatedly.
• Pertussis rates among adults have gone up 16-fold in the past 15 years.
• Children, teens and adults with undiagnosed pertussis can spread the disease to others. In fact, 90% of unvaccinated children living with someone who has pertussis will get the disease.

Avoid Contact With Others to Prevent Spread

The CDC recommends that:

• People with pertussis stay home and avoid contact with others until finishing treatment.
• Anyone exposed to pertussis be treated with an antibiotic to prevent infection.

Outbreaks can occur in a community at any time of year but are more likely in summer and fall. Pay attention to any announcements of an outbreak in your community so you can be sure to take steps to protect yourself and your family.

How Vaccines Work:

• The Tdap vaccine is a killed vaccine that protects against tetanus, diphtheria and pertussis.
• The body makes antibodies to fight off the pertussis bacteria in the vaccine.
• These antibodies remain in the body’s immune system.
• If the body is exposed to pertussis bacteria, the antibodies respond and fight it off.
• Protection from pertussis decreases over time.
• Vaccination with a booster is needed every ten years to stay protected.
• The risks associated with pertussis, tetanus or diphtheria infection are far greater than the possible side effects of the DTaP and Tdap booster vaccines that prevent these deadly diseases among young children, adolescents and adults.
• The Tdap booster vaccine extends protection against tetanus and diphtheria as well as pertussis among adults and adolescents.