Pertussis (patient information)

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 * Assistant Editor(s)-in-Chief: Ethan Leeman

Overview
Pertussis, or Whooping cough, is an infectious bacterial disease that causes uncontrollable coughing. The name comes from the noise you make when you take a breath after you cough. You may have choking spells or may cough so hard that you vomit. Anyone can get whooping cough, but it is more common in infants and children. It's especially dangerous in infants. The coughing spells can be so bad that it is hard for infants to eat, drink or breathe. Before there was a vaccine, whooping cough was one of the most common childhood diseases and a major cause of childhood deaths in the U.S. There are fewer cases today because there are both pertussis-only vaccines and combination vaccines for tetanus, diphtheria and pertussis. If you have whooping cough, treatment with antibiotics may help if given early.

What are the symptoms of Pertussis?
Pertussis can cause serious illness in infants, children and adults. The disease starts like the common cold, with runny nose or congestion, sneezing, and maybe mild cough or fever. But after 1–2 weeks, severe coughing begins. Infants and children with the disease cough violently and rapidly, over and over, until the air is gone from their lungs and they're forced to inhale with a loud "whooping" sound. Pertussis is most severe for babies; more than half of infants less than 1 year of age who get the disease must be hospitalized. About 1 in 20 infants with pertussis get pneumonia (lung infection), and about 1 in 100 will have convulsions. In rare cases, pertussis can be deadly, especially in infants.

Who is at highest risk?
As noted above, Pertussis much more serious for babies and infants, often requiring hospitalization.

What causes Pertussis?
People with pertussis usually spread the disease by coughing or sneezing while in close contact with others, who then breathe in the pertussis bacteria. Many infants who get pertussis are infected by parents, older siblings, or other caregivers who might not even know they have the disease.

When to seek urgent medical care?
When you or your child develops a cold that includes a prolonged or severe cough, it may be pertussis. The best way to know is to contact your doctor.

Diagnosis
Methods used in laboratory diagnosis include culturing of nasopharyngeal swabs on Bordet-Gengou medium, polymerase chain reaction (PCR), direct immunofluorescence (DFA), and serological methods. The bacteria can be recovered from the patient only during the first three weeks of illness, rendering culturing and DFA useless after this period, although PCR may have some limited usefulness for an additional three weeks. For most adults and adolescents, who often do not seek medical care until several weeks into their illness, serology is often used to determine whether antibody against pertussis toxin or another component of B. pertussis is present at high levels in the blood of the patient. By this stage they have been contagious for some weeks. Because of this, adults, who are not in great danger from pertussis, are increasingly being encouraged to be vaccinated.

Treatment options
If started early enough, antibiotics such as erythromycin can make the symptoms go away more quickly. Unfortunately, most patients are diagnosed too late, when antibiotics aren't very effective. However, the medicines can help reduce the patient's ability to spread the disease to others.Infants younger than 18 months need constant supervision because their breathing may temporarily stop during coughing spells. Infants with severe cases should be hospitalized.

Other treatment options include:
 * An oxygen tent with high humidity may be used.
 * Fluids may be given through a vein if coughing spells are severe enough to prevent the person from drinking enough fluids.
 * Sedatives (medicines to make you sleepy) may be prescribed for young children.
 * Cough mixtures, expectorants, and suppressants are usually not helpful and should NOT be used.

Where to find medical care for Pertussis?
Directions to Hospitals Treating Pertussis)

What to expect (Outlook/Prognosis)?
Pertussis can be prevented if the child is properly vaccinated for it. It's especially dangerous in infants. The coughing spells can be so bad that it is hard for infants to eat, drink or breathe. Before there was a vaccine, whooping cough was one of the most common childhood diseases and a major cause of childhood deaths in the U.S. There are fewer cases today because there are both pertussis-only vaccines and combination vaccines for tetanus, diphtheria and pertussis. If you have whooping cough, treatment with antibiotics may help if given early.

Possible complications
ertussis is most severe for babies; more than half of infants less than 1 year of age who get the disease must be hospitalized. About 1 in 20 infants with pertussis get pneumonia (lung infection), and about 1 in 100 will have convulsions. In rare cases, pertussis can be deadly, especially in infants.

Prevention
The best way to prevent pertussis is to get vaccinated. In the US, the recommended pertussis vaccine for children is called DTaP. This is a safe and effective combination vaccine that protects children against three diseases: diphtheria, tetanus, and pertussis. For maximum protection against pertussis, children need five DTaP shots. The first three shots are given at 2, 4, and 6 months of age. The fourth shot is given between 15 and 18 months of age, and a fifth shot is given when a child enters school, at 4–6 years of age. Parents can also help protect infants by keeping them away as much as possible from anyone who has cold symptoms or is coughing. Vaccine protection for pertussis, tetanus, and diphtheria can fade with time. Before 2005, the only booster vaccine available contained tetanus and diphtheria (called Td), and was recommended for adolescents and adults every 10 years. Today there are boosters for adolescents and adults that contain tetanus, diphtheria, and pertussis (called Tdap). Pre-teens going to the doctor for their regular check-up at age 11 or 12 years should get a dose of Tdap. Adults who didn't get Tdap as a pre-teen or teen should get one dose of Tdap instead of the Td booster. Most pregnant women who were not previously vaccinated with Tdap should get one dose of Tdap postpartum before leaving the hospital or birthing center. Getting vaccinated with Tdap is especially important for families with and caregivers of new infants. The easiest thing for adults to do is to get Tdap instead of their next regular tetanus booster—that Td shot that they were supposed to get every 10 years. The dose of Tdap can be given earlier than the 10-year mark, so it's a good idea for adults to talk to a healthcare provider about what's best for their specific situation.