Whooping Cough

H320 Assignment #1

What is Whooping Cough?

Whooping cough is a respiratory disease caused by an infection of the bacterium Bordatella pertussis. This is why the disease is also known as pertussis. Although preventable by vaccine, whooping cough is highly contagious, and potentially fatal, especially for infants. The recommended vaccination for babies and children is called DTap, which is a combined vaccine against three separate diseases: diphtheria, tetanus and pertussis. Because the efficacy of the vaccine wanes over time, a booster is recommended every 10 years for teens and adults. This booster has been available since 2005, and is called Tdap.

History of Whooping Cough

By most standards, whooping cough is a relatively recent human infectious disease. Its first recorded appearance was in France in 1414, and the first epidemic was described in 1578 by Guillaume de Baillou. It is caused by an infection of the B. pertussis bacterium, a human-specific pathogen that was first identified in 1900 by researchers Jules Bordet and Octave Gengou. Due in part to its high lability, it proved difficult to isolate but the pair did so in 1906, from the expectorate of Bordet's own son. They described it as a "small ovoid Gram-negative bacterium." (oxfordjournals.org)


Pertussis is of heightened concern lately; in 2012, reported cases peaked in the United States at 48,277, which was the largest number of cases since 1955. It is thought that many more cases go undiagnosed and unreported.


http://cid.oxfordjournals.org/content/49/10/1565.full

Signs and Symptoms of Whooping Cough

Signs of pertussis are typically observed within five to ten days of infection, but may not develop for up to three weeks. Early symptoms resemble a cold, such as a mild cough or fever, but a cough may also be absent. Other common symptoms include a runny nose or periods of apnea, a period of time when breathing pauses. Since the early stages of whooping cough can appear innocuous, the disease is commonly not diagnosed until later, more severe symptoms develop. (cdc.gov)


Later in the development of pertussis, the more traditional symptoms may occur, and can include:


  • many rapid, paroxysmal coughs, followed by a sharp inspiration that is said to resemble a "whoop" from which the disease takes its name. Coughing fits are more common at night;
  • vomiting during or after coughing spells


The duration of coughing can also cause significant exhaustion. Some sources describe a third stage of convalescence, during which coughing may lessen, but may return. Due to the length of time that coughing may persist, this disease is sometimes referred to as the "100-day cough". Infected people are also more vulnerable to other respiratory infections during this period. (cdc.gov)


http://www.cdc.gov/pertussis/about/signs-symptoms.html

Transmission of Whooping Cough

B. pertussis is human-specific, and cannot survive outside of its host. As such, it has evolved to be very efficient at surviving within its host, and to be highly contagious. It is an airborne disease, and spreads from person to person via the coughs and sneezes of an infected person. It is most common to acquire the disease from someone with whom you are spending a lot of time near, and sharing breathing space. (cdc.gov)


Once transmitted, the bacteria attach to the cilia that line the upper respiratory system. The bacteria then release toxins which damage the cilia, and cause the airways to swell. Infected people are most contagious approximately two weeks after their cough begins. Because the effects are less noticeable in adults, infants often catch it from family or caregivers who may be unaware they are carriers of the disease. (cdc.gov)


http://www.cdc.gov/pertussis/about/causes-transmission.html

Complications of Whooping Cough

Whooping cough is most serious in younger populations. Because of the fragility and small size of infants' upper airways, any inflammation or other damage significantly impedes their ability to breathe. Most complications in younger patients are related to infection, coughing-related trauma and paroxysm-induced cerebral hypoxia, and may include:


  • pneumonia
  • encephalopathy
  • apnea
  • seizures
  • failure to thrive
  • death


Older infected persons, such as teens and adults, while at less risk, are also susceptible to complications. In this population, it is more common to observe:


  • pneumonia
  • weight loss
  • loss of consciousness
  • loss of bladder control
  • rib fractures

Pertussis is usually treated with antibiotics; the earlier this treatment starts the more effective it will be. Early diagnosis and treatment also helps to prevent the spread of the disease to others.

http://www.cdc.gov/pertussis/about/complications.html

Recommended control measures for whooping cough

While no vaccine is 100% effective, or 100% safe, the immunization for whooping cough provides a broad immune response against hundreds of bacterial proteins, and are considered to be 80-90% effective.


Due to their close contact with their children, pregnant women are strongly encouraged to get the vaccine, even before the baby is born. Receiving the vaccine during the third pregnancy causes the pregnant mother's body to produce antibodies which will confer short-term protection in the early stages of the infant's life. These antibodies are at their highest level about two weeks after receiving the vaccine. (cdc.gov)


It is recommended in the U.S. that infants and children, for maximum protection, receive a course of five doses, at 2, 4 and 6 months, 15-18 months and 4-6 years. A booster is given to preteens around 11 or 12 years of age. Protection does decrease over time, and boosters are recommended for adults as well. (cdc.gov)


Worldwide, there are an estimated 16 million cases of pertussis each year, resulting in about 195,000 deaths in children. As such, whooping cough is one of the leading causes of vaccine-preventable deaths.

Should Whooping Cough vaccines be mandatory?

The argument in favor of vaccinations in general, and for children specifically, is very strong. The CDC estimates that, between 1994 and 2014, vaccinations prevented 732,000 deaths and 322 million cases of childhood illness. The economic benefits of this prevention are obvious. However, this still does not mean that vaccinations should be mandatory.

Vaccines will always carry a risk of life-threatening allergic reaction, or other adverse side effects. Of particular interest in the broader U.S. culture, governmental mandates can infringe upon highly-valued constitutionally-protected religious and personal freedoms.

In the end, policies other than mandated immunizations are preferable. Even though no mandatory federal laws exist to stipulate immunizations, many other policies are in place to encourage vaccination, including policies for attending public schools.