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Health blog

Whooping Cough on the Upswing in California

California reported more than 9,100 cases of whooping cough in 2010, making it the biggest breakout since 1947. While cases declined over the next two years, pertussis is once again on the rise. By December 31, 2013, doctors had reported more than 1,900 cases of whooping cough to the California Department of Public Health. According to the Centers for Disease Control and Prevention (CDC), over 48,000 cases of whooping cough were reported in 2012, the highest number of cases in half a century. Many more cases go undiagnosed and unreported.

What is it?
Whooping cough, also known as pertussis, is caused by the bacteria Bordetella pertussis. About eight out of ten cases of pertussis in California occur in children under age 18. Pertussis is highly contagious, and is spread by droplets spewed into the air by infected people when they sneeze or cough. One person with pertussis can infect as many as fifteen other people.

Symptoms typically develop within seven to ten days after exposure and include runny nose and eyes, low fever and a mild cough. Days later, fits of coughing begin, often followed by a high-pitched whoop in many, but not all people. Infants may not whoop at all; instead they may stop breathing for a few seconds as they try to catch their breath after a coughing spell.

People may cough so much that they throw up or break ribs. The coughing may last ten weeks or more. Whooping cough can cause serious illness in infants, children and adults. It can be deadly to infants. About half of children under one year old must be hospitalized for treatment of whooping cough. Complications include pneumonia, seizures, breathing difficulties and encephalopathy (brain disease).

Curing pertussis
Like other bacterial infections, antibiotics usually can cure pertussis if given early enough. However, in most cases, the diagnosis is made too late for antibiotics to work. Because early symptoms of pertussis resemble those of the common cold, people may not immediately seek medical care.

The bacteria attach to the cilia, the tiny hair-like structures that line the respiratory system. The bacteria release toxins which damage the cilia. By the time the patient sees a doctor, the bacteria have often disappeared, and little or nothing can be done for the cough. Recovery is slow because it takes a long time for the cilia to heal.

Preventing pertussis
Vaccination is the best way to prevent pertussis. The CDC recommends children receive five doses of DTaP (diphtheria, tetanus, and pertussis) at: two months, four months, six months, between 15-18 months, and between four to six years. Children who are not immunized are eight times more likely to develop pertussis than are children who are fully immunized.

A booster shot of a similar vaccine called TDaP (tetanus, diphtheria, and pertussis) is recommended at 11 or 12 years of age. Adolescents and adults who didn't get TDaP as a preteen should get a booster. Getting TDaP is especially important for pregnant women and for those of any age caring for young infants.

Everyone needs a tetanus booster every ten years. Many doctors now recommend the TDaP vaccine instead of the plain tetanus booster. If it’s been a long time since your last tetanus booster, ask your doctor if TDaP is right for you. Parents and grandparents of very young children also should check with their doctors to see if they need a pertussis booster.

A report published in Pediatrics (the journal of the American Academy of Pediatrics) in September 2013, found a major cause of the 2010 California pertussis epidemic was parents who refused to have their children vaccinated for pertussis because of personal or religious beliefs.

Despite years of studies by prestigious organizations showing that vaccination is safe, some parents remain reluctant to have their children vaccinated. For example, an article in the Sacramento Bee in September 2013 found the number of children in surrounding counties who start kindergarten without being vaccinated jumped by 30% over the past school year.

Good “cough etiquette” can also help prevent the transmission of pertussis and other infectious diseases. Simply covering the mouth and nose when sneezing, disposing of used tissue, and thorough hand-washing go a long way towards keeping your and your little ones well.

You can learn more about whooping cough at the California Department of Public Health website at: http://www.cdph.ca.gov/HealthInfo/discond/Pages/Pertussis.aspx, or the CDC website at: www.cdc.gov/pertussis/. Listen to a recording of a typical whoop in an infant at: www.pkids.org/diseases/pertussis.html.

Resources: CDC: http://www.cdc.gov/pertussis/; California Department of Public Health: http://www.cdph.ca.gov/HealthInfo/discond/Documents/Pertussis%20report%2012-18-2013.pdf
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