August 20, 2010
Dear Mayo Clinic:
Is it true that my infant son could get whooping cough if he is exposed, even though he has been getting his vaccinations? How common is whooping cough? I assumed it was basically eliminated in the United States.
Yes, infants are susceptible to whooping cough, also known as pertussis.
Whooping cough is a highly contagious bacterial infection that causes a severe, hacking cough. The coughing spells can be followed by a high-pitched intake of breath that sounds like "whoop" and gives the disease its name. Coughing spasms can cause extreme fatigue and vomiting and make breathing difficult. In babies, with their tiny airways, the disease can be very serious.
Vaccinations are the best way to prevent whooping cough. Infants should be vaccinated at ages 2, 4, and 6 months. The whooping cough vaccination is given in combination with tetanus and diphtheria vaccines. On your child's immunization chart, you'll likely see the vaccination recorded as DTaP for diphtheria, tetanus and acellular pertussis. If your baby has not yet had the full course of whooping cough vaccinations, he is not fully immune.
Boosters are recommended at 12 to 18 months; 4 to 6 years; and again at age 11. Pertussis booster shots are available for adults, too, and are a good idea for those in close contact with infants. Ask your physician if you can receive Tdap (tetanus-diphtheria-acellular pertussis) vaccine instead of the usual Td (tetanus-diphtheria) booster.
Pertussis vaccines are very safe, effective and beneficial. Before the vaccine was available, whooping cough was a greatly feared disease that killed thousands of children every year. Now, perhaps 10 to 20 deaths a year in the United States are due to whooping cough. Almost all deaths occur in young infants.
People of all ages still contract the disease. Since the 1980s, whooping cough incidence has been increasing in the United States. In a typical year, 5,000 to 10,000 cases are reported, according to the Centers for Disease Control and Prevention (CDC). But epidemics occur every three to five years. In 2005, more than 25,000 cases were reported in the United States.
We continue to see whooping cough for several reasons. One, vaccinations aren't universal. The CDC estimates that about 85 percent of children between ages 19 and 35 months are fully immunized. And, over time, the vaccine's effectiveness wanes, so we see adolescents and adults with whooping cough. These older patients typically have a milder form of the illness because they retain some immunity from early vaccinations. But patients with mild pertussis are still contagious. The disease can be transmitted via germ-laden droplets propelled into the air from a cough or sneeze.
Pertussis is typically diagnosed by inserting a thin swab through the nose into the back of the throat. The swab is then sent for culture or other more rapid tests. Neither culture nor the other tests are always positive, so some patients will be treated based on symptoms. The mainstay of treatment is antibiotics. Children with whooping cough should be kept home from school or day care until they have had five days of antibiotics. A doctor may recommend antibiotics for everyone in the household because whooping cough is easily transmitted.
Medications work best when given early in the course of the illness. Since patients often aren't diagnosed until the cough has persisted for a time, treatment doesn't immediately stop the cough. Whooping cough is also called the 100-day cough because symptoms can linger that long.
Home care includes plenty of rest and fluids. Cough medications aren't helpful and aren't recommended. Infants may need to be monitored in a hospital to make sure they can breathe on their own after a coughing spell.
To protect your baby from whooping cough, stay on track with immunizations. Make sure that family members and caregivers are fully vaccinated against pertussis and keep your baby away from anyone with a persistent cough.
— Thomas Boyce, Pediatric Infectious Diseases, Mayo Clinic, Rochester, Minn.