TRANSCRIPT
43. Whooping Cough Is On the Rise: An On Medical Grounds Medical Scoop
43. Whooping Cough Is On the Rise: An On Medical Grounds Medical Scoop
Do you know what that is? Even if you are a healthcare provider, you may not have heard it before. Listen again. That is the sound of whooping cough.
I'm Jane Caldwell, your host of On Medical Grounds, and today we are going to give you the scoop on whooping cough, also known by the less friendly name, pertussis, the infection caused by the crafty and toxin-producing bacteria Bordetella pertussis.
According to data from the CDC, rates of whooping cough are currently 3X higher than in 2023 and still climbing. Why? The short answer is that whooping cough can be difficult to diagnose and that like other childhood vaccinations, vaccination rates are down. But that doesn’t explain the whole story.
That story starts in Paris in 1578, where an epidemic of a severe and angry-sounding cough spread like wildfire and became known as the “cough of 100 days.” That 100-day timeframe is important for two reasons. First, because even though whooping cough is characterized by that distinguished sounding cough we just heard, other seasonal respiratory viruses and bacteria can also produce a cough, making whooping cough hard to distinguish, particularly in early infection. Second, symptoms of whooping cough present in stages. The first stage of whooping cough lasts 1-2 weeks, and may include fever and runny nose as well as periods of apnea in infants, but often the cough associated with the early stage may only be mild or even just an occasional cough. Both of these factors result in a lot of symptom overlap in stage 1 whooping cough and numerous other respiratory viruses and bacterial infections.
The characteristic cough is caused by the B. pertussis bacterial toxins damaging the cells that line the upper respiratory system. The bacteria can also cause the airways to swell, leading to the unique “gasping” or “wheezing” sounds associated with whooping cough. Over the years, people referred to this as a “whoop” sound, leading to the name. These paroxysmal “whooping” cough attacks are severe and can last a long time, leading to extreme fatigue and vomiting. The problem with using the cough to diagnose early, is that it doesn’t appear until the second stage of the infection and can last anywhere from one to 10 weeks. Cough is followed by a period of slow healing in stage 3, or the convalescent stage, and recovery can take up to three weeks or longer.
Before vaccination was available, whooping cough was considered a major cause of infant morbidity and mortality. The vaccine was developed in the 1940s and the U.S. prevalence dropped from 250,000 in the prevaccination era to 1,010 cases per year by 1976, when vaccination was more prevalent. Today, it can still be severe in unvaccinated infants and adults and anyone who is immunocompromised or who has moderate to severe asthma. Whooping cough is commonly known to infect 100% of unvaccinated household contacts. Vaccination efficacy wanes to 50% after 12 years, necessitating a booster every 10 years. Currently, approximately 38% of cases occur in infants under 6 months of age, and over 70% of cases are in children under the age of 5, either because they are unvaccinated or have not completed the vaccine series. Worldwide, there are 24 million cases annually.
Most individuals who contract whooping cough recover fully, though it is after months of a protracted illness. Infants and older adults have the highest rates of morbidity and mortality. Secondary complications, such as seizures, pneumonia, and encephalopathy can lead to long-term complications and fatalities.
Whooping cough spreads via droplets from coughing and sneezing from the start of symptoms and for a total of four to five weeks, or approximately two weeks after the stage 2 paroxysmal cough begins. It is considered one of the most highly transmissible respiratory infections. While vaccinations have drastically reduced the rates of whooping cough and the associated morbidity and mortality, U.S. vaccination rates have been declining for several years.
The whooping cough vaccine is usually contained within the childhood DTaP vaccine that includes diphtheria, tetanus, and pertussis. The DTaP is given over a series of 5 immunizations and is for children under the age of 7. The first three vaccinations in the series should be given at 2, 4, and 6 months with boosters at 15-18 months and 4-6 years. Older children and adults should receive the Tdap version of the vaccine every 10 years. Pregnant women should receive a booster between 27 and 36 weeks gestation.
The Healthy People 2030 target for the whooping cough vaccine is a 95% childhood vaccination rate of kindergarteners. As of 2023, the U.S. had dropped to 93%. But overall vaccination rates are only part of the picture. Many children in the U.S. don’t complete the vaccination series, leading to incomplete immunity. Only about 80% of children receive the recommended first four doses in the series by age 2.
Most cases of whooping cough in the U.S. and globally are related to unvaccinated children and adults. Encouraging vaccination is the primary way to prevent the spread of this highly contagious infection. Early detection and treatment can also prevent the spread to household and other contacts.
This brings us to the end of our short medical scoop on whooping cough. Remember this sound, because even if you’ve never heard it before, you may hear it again. And stay tuned to On Medical Grounds for more expert interviews and medical news.
At OMG, we also feature complimentary teaching slides and continuing education credits on selected podcasts. At OnMedicalGounds.com and on our OMG app, we provide perks to all posted podcasts by linking content so you can drink in more if you so choose. Please be sure to click the subscribe button to be alerted when we post new content or download our app to get all of our podcasts, slides, and continuing education credits in one convenient location. If you enjoyed this podcast, please rate and review it and share it with your friends and colleagues. This podcast is protected by copyright and may be freely used without modification for educational purposes. To find more information or to inquire about commercial use, please visit our website OnMedicalGrounds.com.
References
https://www.ncbi.nlm.nih.gov/books/NBK519008/#:~:text=Pertussis%2C%20%E2%80%9Ca%20violent%20cough%2C,was%20developed%20in%20the%201940s.
https://www.cdc.gov/pertussis/about/index.html
Seither R, et al. MMWR Morb Mortal Wkly Rep. 2023;72:1217–1224.
https://www.immunize.org/wp-content/uploads/catg.d/p2055.pdf. Updated March 12, 2024. Accessed July 5, 2024.
https://www.cdc.gov/nchs/fastats/immunize.htm#:~:text=Data%20are%20for%20the%20U.S.,7%2Dvaccine%20series:%2069.7%25
I'm Jane Caldwell, your host of On Medical Grounds, and today we are going to give you the scoop on whooping cough, also known by the less friendly name, pertussis, the infection caused by the crafty and toxin-producing bacteria Bordetella pertussis.
According to data from the CDC, rates of whooping cough are currently 3X higher than in 2023 and still climbing. Why? The short answer is that whooping cough can be difficult to diagnose and that like other childhood vaccinations, vaccination rates are down. But that doesn’t explain the whole story.
That story starts in Paris in 1578, where an epidemic of a severe and angry-sounding cough spread like wildfire and became known as the “cough of 100 days.” That 100-day timeframe is important for two reasons. First, because even though whooping cough is characterized by that distinguished sounding cough we just heard, other seasonal respiratory viruses and bacteria can also produce a cough, making whooping cough hard to distinguish, particularly in early infection. Second, symptoms of whooping cough present in stages. The first stage of whooping cough lasts 1-2 weeks, and may include fever and runny nose as well as periods of apnea in infants, but often the cough associated with the early stage may only be mild or even just an occasional cough. Both of these factors result in a lot of symptom overlap in stage 1 whooping cough and numerous other respiratory viruses and bacterial infections.
The characteristic cough is caused by the B. pertussis bacterial toxins damaging the cells that line the upper respiratory system. The bacteria can also cause the airways to swell, leading to the unique “gasping” or “wheezing” sounds associated with whooping cough. Over the years, people referred to this as a “whoop” sound, leading to the name. These paroxysmal “whooping” cough attacks are severe and can last a long time, leading to extreme fatigue and vomiting. The problem with using the cough to diagnose early, is that it doesn’t appear until the second stage of the infection and can last anywhere from one to 10 weeks. Cough is followed by a period of slow healing in stage 3, or the convalescent stage, and recovery can take up to three weeks or longer.
Before vaccination was available, whooping cough was considered a major cause of infant morbidity and mortality. The vaccine was developed in the 1940s and the U.S. prevalence dropped from 250,000 in the prevaccination era to 1,010 cases per year by 1976, when vaccination was more prevalent. Today, it can still be severe in unvaccinated infants and adults and anyone who is immunocompromised or who has moderate to severe asthma. Whooping cough is commonly known to infect 100% of unvaccinated household contacts. Vaccination efficacy wanes to 50% after 12 years, necessitating a booster every 10 years. Currently, approximately 38% of cases occur in infants under 6 months of age, and over 70% of cases are in children under the age of 5, either because they are unvaccinated or have not completed the vaccine series. Worldwide, there are 24 million cases annually.
Most individuals who contract whooping cough recover fully, though it is after months of a protracted illness. Infants and older adults have the highest rates of morbidity and mortality. Secondary complications, such as seizures, pneumonia, and encephalopathy can lead to long-term complications and fatalities.
Whooping cough spreads via droplets from coughing and sneezing from the start of symptoms and for a total of four to five weeks, or approximately two weeks after the stage 2 paroxysmal cough begins. It is considered one of the most highly transmissible respiratory infections. While vaccinations have drastically reduced the rates of whooping cough and the associated morbidity and mortality, U.S. vaccination rates have been declining for several years.
The whooping cough vaccine is usually contained within the childhood DTaP vaccine that includes diphtheria, tetanus, and pertussis. The DTaP is given over a series of 5 immunizations and is for children under the age of 7. The first three vaccinations in the series should be given at 2, 4, and 6 months with boosters at 15-18 months and 4-6 years. Older children and adults should receive the Tdap version of the vaccine every 10 years. Pregnant women should receive a booster between 27 and 36 weeks gestation.
The Healthy People 2030 target for the whooping cough vaccine is a 95% childhood vaccination rate of kindergarteners. As of 2023, the U.S. had dropped to 93%. But overall vaccination rates are only part of the picture. Many children in the U.S. don’t complete the vaccination series, leading to incomplete immunity. Only about 80% of children receive the recommended first four doses in the series by age 2.
Most cases of whooping cough in the U.S. and globally are related to unvaccinated children and adults. Encouraging vaccination is the primary way to prevent the spread of this highly contagious infection. Early detection and treatment can also prevent the spread to household and other contacts.
This brings us to the end of our short medical scoop on whooping cough. Remember this sound, because even if you’ve never heard it before, you may hear it again. And stay tuned to On Medical Grounds for more expert interviews and medical news.
At OMG, we also feature complimentary teaching slides and continuing education credits on selected podcasts. At OnMedicalGounds.com and on our OMG app, we provide perks to all posted podcasts by linking content so you can drink in more if you so choose. Please be sure to click the subscribe button to be alerted when we post new content or download our app to get all of our podcasts, slides, and continuing education credits in one convenient location. If you enjoyed this podcast, please rate and review it and share it with your friends and colleagues. This podcast is protected by copyright and may be freely used without modification for educational purposes. To find more information or to inquire about commercial use, please visit our website OnMedicalGrounds.com.
References
https://www.ncbi.nlm.nih.gov/books/NBK519008/#:~:text=Pertussis%2C%20%E2%80%9Ca%20violent%20cough%2C,was%20developed%20in%20the%201940s.
https://www.cdc.gov/pertussis/about/index.html
Seither R, et al. MMWR Morb Mortal Wkly Rep. 2023;72:1217–1224.
https://www.immunize.org/wp-content/uploads/catg.d/p2055.pdf. Updated March 12, 2024. Accessed July 5, 2024.
https://www.cdc.gov/nchs/fastats/immunize.htm#:~:text=Data%20are%20for%20the%20U.S.,7%2Dvaccine%20series:%2069.7%25
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