Thursday, November 7, 2013

Did I Hear a WHOOP?

As a Texas Aggie, I generally love to hear a "WHOOP" (especially during football season- gig 'em, Ags!) However, as a doctor, the word or sound "whoop" triggers concerns about Pertussis, the bacteria that causes whooping cough, which has been unfortunately on the rise in our community and across the United States.

What is whooping cough?

This highly infectious respiratory disease only infects humans, and causes nearly 50 million cases of disease each year. In the United States, we only see around 40,000 documented cases/year, but certainly have many more infections that are not recognized and treated.  Smokers, asthmatics, infants, pregnant mothers and people with compromised immune systems are at the highest risk for catching pertussis, but we are also seeing outbreaks in healthy, previously immunized populations (whose immunity has worn off over the years since their last booster vaccine.)

There are several stages of whooping cough infections. The first stage is like a common cold- stuffy, runny nose, low grade temperature and a slight cough. However, the second stage is what sets this disease apart. Instead of a mild lingering cough, the cough becomes more frequent and can be intensely severe- causing fits and spasms of coughing so hard that you vomit, and occasionally creating a "whoop" sound as you suck in air after a fit of coughing. Typically people describe this as the "worst cough" they have ever had. Finally, there is a several week convalescent stage where the cough gradually decreases and fades away.

How is pertussis diagnosed?

For a variety of reasons, doctors do not often test for pertussis. The test for pertussis requires a specific nasal swab that should be immediately sent off to the health department lab for evaluation. Blood tests can help to confirm an acute case as well (checking antipertussis toxin IgG levels).

How is pertussis treated?

Short courses of azithromycin or erythromycin will eliminate the virus from the upper respiratory tract. More serious infections (especially in infants) may require hospitalization for more aggressive treatment.

Why can't I get a zpak for my cough?

The vast majority of coughs are NOT pertussis, and in fact, are not caused by ANY bacterial source. The zpak, or any antibiotic, will only help improve coughs caused acutely by a bacterial infection (such as a pneumonia). The good news here is that although coughs can hang on for up to six weeks after a viral infection or with allergies, we do have other (non-antibiotic) medications such as broncho-dilating inhalers that can help clear them up.

How can I prevent pertussis? 

In a flashback to the previous blog on TETANUS, here is your answer: All children should receive the combination vaccine DTaP (diphtheria, tetanus and pertussis) five times in early childhood, at 2, 4, 6, 15-18 months, and age 4-6 years. Then, at 11-12 years, they should receive a BOOSTER combination vaccine, called Tdap (which has lesser, booster-level doses of the diphtheria and pertussis portions, noted with the lower case letters). Finally, everyone over the age of 19 who did NOT receive that Tdap during adolescence should get a one time vaccination with Tdap "now", regardless of the interval since their last tetanus booster, which was most likely simply a Td (tetanus/diptheria booster).

What's that little "a" for in Tdap and DTaP? 

That little "a" is for "acellular" pertussis. There were concerns about side effects from the original whole cell pertussis vaccines, so scientists were able to develop a newer version of the vaccine that only used a small portion of the pertussis cell. This section of the bacteria is still "large" enough to trigger a robust immune response, yet has fewer side effects.

BOTTOM LINE: Adults who have never received a tetanus booster that contains pertussis should update their immunizations at their next check up!

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