Whooping Cough Is Very Serious Especially For Young Children

Question: My neighbour’s children have been coughing for the past two weeks. Yesterday their mother told me that they may have whooping cough. These children come over to our house everyday and play with our children. I am terrified that our children (two- and four-years-old) will get sick. Is there anything that I can do to prevent them from catching whooping cough?

Answer:

Whooping cough is caused by a germ called Bordetella pertussis. It is a very small germ that is spread by coughing in infected people. Most young children infected with these bacteria will develop whooping cough, especially if they did not receive full immunization. Older children and adults will have some cough, although their symptoms are usually milder.

Typical whooping cough has 3 stages: catarrhal, paroxysmal, and convalescent. When a child breathes in infected secretion from another person, the bacteria will multiply in the back of the nose. The incubation period, or the time between infection and onset of illness, is usually seven to 10 days, although it can be as long as twenty days. The disease often begins with mild cold-like symptoms with little or no fever. This is called the catarrhal stage.

In one to 3 weeks, the paroxysmal stage of whooping cough will begin. The cough spasms are most severe in infants and young children who are not fully immunized. There are several coughs with each breath, sometimes to the point of “losing the breath” completely. The face of the child can turn quite red, or even blue, in severe cases. Many children will spit up mucus, and vomiting after cough is not uncommon. Young infants can lose weight and become malnourished because of repeated vomiting. In between cough spasms, the child can appear to be quite normal.

The characteristic “whoop” is a noise that can occur at the end of a cough spasm, when the child takes a breath in. This “whoop” may not be present in children younger than 6 months of age, and is uncommon in adults. The paroxysmal stage can last two to four weeks. In the convalescent or recovery stage, the coughs are less frequent and less severe.

When young infants come down with whooping cough, they can develop severe breathing problem or stop breathing altogether, a condition that is called “apnoea.” Many young children with whooping cough need to be treated in hospital with specialized care. Other complications include pneumonia, convulsions, brain disorder and death.

Research has shown that many adults infected with whooping cough bacteria never develop severe cough. They are often unrecognized until their children were diagnosed with whooping cough. However, secretions from these adults are very infectious; they can spread the germs to other children or adults at work and at home.

If your neighbor’s kids are suffering from whooping cough, and if your children have played with them recently, there is good chance that your children have already been infected. Sometimes you can prevent severe whooping cough by taking an antibiotic before the onset of illness. Erythromycin for ten to 14 days is very effective in killing the bacteria. If you have experienced abdominal pain with erythromycin before, you should consult your family physician to see whether you can take the newer antibiotics (clarithromycin or azithromycin) which are gentler on the stomach. If you are truly allergic to erythromycin (like getting a bad rash), a medicine called Septra can be effective too.

If your children have not been fully immunized with whooping cough vaccine, they can get a booster dose as soon as possible. Getting the booster vaccine can reduce the severity of whooping cough. You can consult the public health nurse or your family doctor for uptodate guidelines on booster immunization.

[Note to Readers: Due to recent resurgence of whooping cough in North America, it is even more important to get immunized with whooping cough vaccine.  Unfortunately, the new acellular whooping cough vaccine is not as effective as the whole-cell vaccine.  There is also evidence that the whooping cough bacteria have mutated, which makes the vaccine less effective.]