Pertussis, an old foe

Pertussis, an old foe

Pertussis (whooping cough) is a potentially devastating bacterial infectious condition involving the human respiratory tract. The disease begins with mild upper respiratory symptoms similar to common cold (catarrhal stage) lasting an average of two weeks which progresses to paroxysms of cough (paroxysmal stage) characterized by inspiratory whoop. Subsequently the symptoms wane gradually over a few weeks (convalescent stage) to potentially months. The incubation period is 7-10 days. Fever is usually absent or minimal.

Whooping cough in infants younger than 6 months of age can be atypical with a short catarrhal stage, gagging, gasping or apnea as prominent early manifestations; absence of whoop; and prolonged convalescence. The disease can be severe in young infants particularly if unimmunized or preterm with case fatality rate of approximately 1%. The duration of classic pertussis is 6 to 10 weeks. Complications among infants can include pneumonia (22%), seizures (2%), encephalopathy (0.5%), and even sudden death. The illness in immunized children and adults can be mild and unrecognized. In adults the disease may only present with prolonged cough. Infected people are most contagious during the catarrhal stage and the first two weeks after cough onset.

Factors affecting the spread of whooping cough include age, immunization status or previous episode of pertussis, and appropriate antimicrobial therapy.

Humans are the only known hosts of Bordetella Pertussis the bacteria causing whooping cough. Transmission occurs by close contact with index patient via aerosolized droplets. Your health care provider may collect a nasal or throat specimen and send it to a lab for disease confirmation. Since neither infection nor childhood immunization provides life long immunity, recent efforts to give booster immunizations to adults have been of paramount importance.

Antimicrobial agents administered after the cough is established have no discernible effect on the course of the illness but may ameliorate the disease in the catarrhal stage and are recommended to limit the spread of organism to others.

Pertussis is considered a "family" disease. It is highly recommended that all exposed family members or close contacts be treated with antibiotics regardless of their immunization status. Older siblings and adults with mild or unrecognized atypical disease are important sources of pertussis for infants and young children.

Students, staff members, and child care providers with pertussis should be excluded from schools until they have completed 5 days of recommended antimicrobial therapy. Close contacts younger than 7 years of age or older than 10 years of age who are unimmunized or underimmunized should have age appropriate pertussis immunization initiated . Pregnancy is not a contraindication to pertussis immunization.

Age specific immunizations and contact precaution with isolation are the most effective controlling measures presently. Your health care provider and the CDC website are always available for your questions and concerns. 

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