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By: Kenneth Ripp, M.D.
Pertussis, also known as whooping cough, was a very common childhood illness less than a century ago. Widespread immunizations against pertussis caused a dramatic decline in the disease. However, according to the Center for Disease Control, the incidence has increased steadily since 1980 when 1,700 cases were reported in the United States. As a comparison, in 2002, 8,296 cases were reported. In recent weeks, there has been one confirmed case reported in Carlton County.
Pertussis is a highly contagious bacterial infection of the upper respiratory system. It is spread from person to person through respiratory secretions, which are released into the air when an infected person coughs or sneezes. The incubation period is from seven to 14 days.
The most commonly identified symptom is a severe and persistent cough. Other symptoms can seem cold-like and include sneezing, runny nose, watery eyes, and mild fever. The disease can last for six to 10 weeks, and as it progresses, coughing worsens. During a coughing episode, the intensity and repetition of coughs may make it temporarily difficult to take a breath. Vomiting and severe exhaustion may also follow a coughing spell. Typically, coughing peaks about three weeks into the illness, and then gradually decreases over time.
Immunization for babies has become routine. According to the Minnesota Department of Health, over 96 percent of Minnesota children have received at least three doses of the vaccine before their third birthday. While immunized children are most likely protected against pertussis, the vaccine decreases in effectiveness over time. It is estimated that most people are left unprotected within a decade of their last booster. Current recommendations include an initial immunization at six weeks of age, with four boosters by age six.
This leaves most adults unprotected against the disease. Currently the vaccine is not recommended for adolescents or adults for a couple of reasons. Usually the disease is less severe in these groups, and the side effects of the vaccine may be greater. However, while adolescents and adults may not get seriously ill, they may come in contact with infants who are at higher risk for serious complications from pertussis, and spread the disease to them.
Pertussis can be difficult to diagnose, because it closely resembles a common cold in its early stages. As symptoms progress, however, they become more distinctive of whooping cough. To confirm a diagnosis, a culture is taken from the back of the throat and is tested for the specific types of bacteria that cause the disease.
Whooping cough is usually treated with antibiotics, which help reduce the spread of infection. If started early, antibiotics can help shorten the illness. Home treatment measures include using a cool air humidifier, maintaining a calm, restful environment, providing small sips of fluids, and minimizing coughing triggers such as smoke and dust.
Adults over 60 and babies younger than four months are at greater risk for developing severe complications from the disease. These include pneumonia, seizures, encephalopathy, exertion-related injuries such as hernia, and even death. Infants are often hospitalized to ensure that they are getting enough fluids and nutrients. This also allows for monitoring of the baby to make sure that he or she is recovering adequately from coughing episode. If needed, a baby may also receive oxygen therapy.
Although pertussis can be a serious disease, it most often is treated successfully with antibiotics and rest. Adults with mild pertussis may not even realize they have the disease. However, an adult with mild pertussis is contagious and could spread the disease to an unvaccinated infant. That is why it is important for infants to be immunized according to recommendations. An unprotected infant has a much greater risk for developing severe complications from the illness. Treatment with antibiotics during the early stages of the disease can actually help shorten the illness. If you suspect that someone in your family may have pertussis, contact your health care provider immediately.
Dr. Ripp is a board certified family practice physician at Raiter Clinic in Cloquet.