Whooping Cough Information for Health Care Providers
Whooping Cough (Pertussis) Overview
Commonly known as whooping cough, pertussis is a highly contagious respiratory infection caused by exposure to airborne Bordetella pertussis bacteria. When a patient with pertussis coughs, the disease is easily transferred to those within close proximity.
Increasing Number of Cases
The number of pertussis cases in all age groups is rising across the country at a rate of great concern to the medical and public health communities. In 1976, a record low of 1,010 cases were reported. In 2004 more than 25,000 cases were reported and in 2005 at least 20,000 are suspected. But reported numbers do not necessarily provide an accurate picture. In actuality, the number of annual cases may be close to one million. Symptoms can be mild, initially similar to a common cold, which makes it difficult to diagnose. By the time the persistent cough becomes apparent, pertussis may no longer be detectable. Some patients may have only a slight cough, apnea, or no symptoms at all.
Symptoms
Symptoms usually appear within seven to 10 days of infection. After the initial coryza, the infection causes paroxysms of cough that can last for months, and may be so severe that it can be difficult for the patient to breathe, eat or sleep. In some cases, a coughing attack may cause vomiting or cyanosis. Complications linked to the disease include pneumonia, seizures, encephalitis, and - in rare cases - death.
Prevention
The pertussis vaccine series (part of DTaP) begins at two months of age and most infants are immune by the time they are 7-12 months old. But for children to be fully immune, they need two more DTaPs, one at 12-15 months and another at 4-6 years of age. For generations, childhood vaccination has kept the disease under control. However, immunity from early childhood vaccination wanes after 5 to 10 years, leaving adolescents and adults susceptible to the disease.
Parents and other close contacts often are responsible for transmitting pertussis to infants who are vulnerable until they receive all their vaccines. Infants are also more susceptible to severe pertussis, serious complications, and even death.
The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) recommends that adolescents and adults receive a Tdap (tetanus-diphtheria-acellular pertussis) booster vaccine to protect against pertussis instead of the previously recommended Td (tetanus-diphtheria) booster. Booster vaccination is especially important for patients in contact with infants younger than 12 months of age. Patients who need the pertussis vaccine can take Tdap as long as they have not received the Td booster within the past two years.
Costs Associated with Pertussis
The average cost for a hospital stay related to pertussis is more than $13,000. Longer stays can cost as much as $69,000. The majority of infected adults miss an average of 9.8 days of work, and adolescents with pertussis miss an average of 5.5 days of school. Parents lose an average of six days of work to care for a child with pertussis.
Whooping Cough Studies
Bisgard KM, Pascual FB, Ehresmann KR, et al. Infant pertussis: who was the source? Pediatr Infect Dis J 2004;23(11):985-989.
Lee HL, Pichichero ME. Costs of Illness Due to Bordetella Pertussis in Families. Arch Fam Med. 2000;9:989-996.
Immunization Schedules
The U.S. Centers for Disease Control and Prevention (CDC) recommends that health care providers follow the recommended immunization schedules for children, adolescents and adults. The vaccination schedules, one for children and adolescents and the other for adults, provides a comprehensive summary of recommendations for vaccine-preventable diseases. The schedules are designed as a convenient, up-to-date tool for health care providers for assessing the vaccine needs of children and adult patients during office visits, and indicate the appropriate times to administer vaccines.
Childhood/Adolescent Immunization Schedule, Including Catch-up Schedule
Adult Immunization Record
The Immunization Action Coalition has designed an easy-to-carry tri-fold adult immunization record card making it easier for patients to record their vaccinations and review when they need to be updated. To obtain a sample adult immunization record, please visit: Immunization Action Coalition's Adult Immunization Record Card
Resources
Provisional Adult Recommendations
» National Foundation for Infectious Diseases
» National Partnership for Immunization (NPI)
» Visiting Nurse Associations of America
» Society for Adolescent Medicine
» Parents of Kids With Infectious Diseases
» Pertussis.com
» Immunization Action Coalition (IAC)
» Centers for Disease Control and Prevention (CDC)
» Advisory Committee for Immunization Practices (ACIP)
» Mayo Clinic
» MMWR: Use of Tdap, ACIP Recommendations