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Whooping Cough Hits Reedsport
by Janet E. Patin, MD, Dunes Family Health Care

Reedsport has three confirmed cases of pertussis ("whooping cough"), a contagious illness that was once a scourge of society. The percussive coughing spasms and characteristic "whoop"-sounding gasp between them can have serious effects on infants, especially those younger than a year of age, including pneumonia, seizures, and brain damage. More than half of infants who get the disease must be hospitalized. In 1940, there were over 183,000 cases in the US, but infection has dropped 98% due to active vaccination of infants. Pertussis is an annoying and persistent infection in older children and adults, but less likely to have serious consequences. Because infants and young children can catch the disease from adults, quarantine and antibiotic treatment are recommended for affected cases and their close contacts.

The cases in Reedsport were found in Mrs. Plotz' second grade class. Pertussis is not airborne; it's spread by droplets that tend to fall within a few feet of the person coughing, laughing, shouting, talking, or singing. It is very contagious among close contacts; that is, everyone who lives with the sick person, persons who were face-to-face and within "spitting distance" for more than one hour, and persons who had direct contact with the sick person's secretions. It can take one to three weeks after exposure for symptoms to appear. At first, pertussis looks like the common cold, with sneezing, runny nose, fever, and mild cough. However, after one or two weeks, the cough becomes more severe, and can last for up to six more weeks. The coughing spasms of pertussis can cause vomiting, and usually don't respond to over-the-counter or prescription medicines to prevent cough.

The public health department, working with the CDC, recommends that all the children in Mrs. Plotz' class be treated with antibiotics, and all their family members also be treated if a child in the class showed symptoms. Erythromycin has been the first-choice antibiotic, but if it causes nausea and can't be taken the full 14 days, there are other options your doctor can prescribe.

If a child in the class did NOT have symptoms, but their family member does, that family member should be cultured for pertussis before treatment. All those receiving antibiotics should be quarantined at home for the first five days of treatment.

While this might seem extreme, the purpose of prophylactic treatment and quarantine is to halt the rapid spread of this serious disease. About 1 child in 10 with pertussis will get pneumonia, and 1 in 50 will have convulsions. In 1 out of every 250 people with pertussis, the brain will be affected ("encephalopathy"). Pertussis kills 10-15 people a year in the US. The four-dose DTaP series protects about 80% of recipients from pertussis, but immunity wanes after 5-10 years, so adults can pick it up and spread the infection.

The vaccine is only recommended for children under seven years of age. If your child has completed the four-dose DTaP series but have not had a shot within three years, they should receive another dose of DTaP now. Close contacts under seven who haven't had the full series should get it, with a minimum of four weeks between each of the first three doses, and six months between the third and fourth dose.

Vaccines work to decrease the risk of children dying or being serious affected by infectious disease. Whooping cough has returned to our community, and we need to fight back with antibiotics and staying home if necessary, to kill it and prevent it from hurting others.

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