Some time in the mid 1940′s my dad started to cough. Week after week, the cough continued. It interfered with his days, kept him awake at night. He was so fatigued he had to drop out of school. His doctor was stumped. Nothing he tried calmed the cough. Finally, his doctor recommended visiting a warm, dry climate, and my dad and grandmother headed out to California where he enrolled in UCLA. Meanwhile back in Detroit, my aunt was taking the bus to work, hacking away. The person sitting next to her said, “You have whooping cough!” When the news reached LA, my dad came back east, began to feel better, and resumed his studies.
When adolescents and adults get whooping cough (pertussis), it’s a substantial annoyance. The cough is unrelenting, often severe enough to cause vomiting, rib fractures, urinary incontinence, and fainting. Once pertussis enters a household, everyone is likely to catch it. If kids under one year old catch it, they will likely land in the hospital and about 1% die. Since the development of pertussis vaccination, U.S. rates of the disease are down about 80%. Eradication is theoretically possible, but difficult.
The vaccine is pretty effective, but no completely, and immunity doesn’t last all that long. Without boosters, kids and adults continue to pass the bacterium around, serving as a disease reservoir. The fewer people who are immune, the more likely an outbreak is to occur. There are still a few things about outbreaks we don’t understand. They occur in a cycle, with the disease numbers jumping up every 3-5 years. What we do know is that during outbreaks, little kids can get very sick and some will die. Infants’ immune systems aren’t able to fight off the infection, and their little bodies can’t handle the toxin pumped out by the bacterium. They often cough so hard that they stop breathing. The primary reason to vaccinate everyone is to prevent infants from dying.
Many outbreaks are preventable, and most are easily controlled with good public health surveillance, attentive parents and doctors, and proper vaccination. Currently, adults (most of whom are no longer immune to pertussis) are advised to get a booster shot. Most will get the TDaP vaccine, which updates tetanus and diphtheria as well. This helps reduce the number of adults who can harbor the bacteria, passing it on to our most vulnerable.
Since the vaccine isn’t completely effective, it’s important that as many people as possible get it; this strategy has worked well, decreasing the number of cases and death considerably. When a case is suspected, alert doctors can test for it and treat it, and close contacts can be given prophylactic antibiotics, helping to contain the outbreak.
Last week I received an email from PalKid’s school: a pertussis case had been reported. We weren’t told details, but all cases were apparently treated, and close contacts give antibiotics. The outbreak didn’t take hold. Part of the success was due to the parents. They were straight-forward about it, contacting those who needed to know and following their doctor’s advice. The rest of the success is probably due to our community’s high vaccination rates. I’m pretty happy about this—I don’t think my kid is ready for UCLA.