Wednesday, November 17, 2010

Health Care and Pertussis

In recent months, a very noticeable rise in the cases of pertussis has occurred in the US, and children have been the most affected by this highly contagious disease. Whooping cough (pertussis) is a highly contagious respiratory tract infection. In advanced stages, it's marked a severe, hacking cough followed by a high-pitched intake of breath that sounds like "whoop." In the first half of the 20th century, whooping cough was a leading cause of childhood illness and death in the United States. But after the introduction of a vaccine, the number of cases gradually declined, reaching a low in the mid-1970s. Since then, however, the incidence of whooping cough has been increasing, primarily among children too young to have completed the full course of vaccinations and teenagers and adults whose immunity has faded, according to the Mayo Clinic.
 
It is a serious disease that can cause permanent disability in infants, and even death, according to Google Health.When an infected person sneezes or coughs, tiny droplets containing the bacteria move through the air, and the disease is easily spread from person to person. The infection usually lasts 6 weeks. Whooping cough can affect people of any age. Before vaccines were widely available, the disease was most common in infants and young children. Now that most children are immunized before entering school, the higher percentage of cases is seen among adolescents and adults.

Initial symptoms, similar to the common cold, usually develop about a week after exposure to the bacteria.

Severe episodes of coughing start about 10 to 12 days later. In children, the coughing often ends with a "whoop" noise. The sound is produced when the patient tries to take a breath. The whoop noise is rare in patients under 6 months of age and in adults. Coughing spells may lead to vomiting or a short loss of consciousness. Pertussis should always be considered when vomiting occurs with coughing. In infants, choking spells are common, according to Google Health. Other pertussis symptoms include:
•Runny nose
•Slight fever (102 °F or lower)
•Diarrhea

Pertussis can be a very serious disease, especially for infants. Rates of hospitalization and complications increase with decreasing age. Children age 3 months and younger accounted for 85% of these death, and the breathing difficulties associated with this disease can be very distressing and scary for the patient and his or her family. Although adults are less likely than infants to become seriously ill with pertussis, most make repeated visits for medical care and miss work, especially when pertussis is not initially considered as a reason for their long-term cough. In addition, adults with pertussis infection have been shown to be an important source of infection to infants with whom they have close contact, according to VaccineInformation.org.
 
Younger patients have a greater chance of complications from pertussis than older patients. The most common complication is secondary bacterial infection, which is the cause of most pertussis-related deaths. Pneumonia occurs in one out of 20 cases; this percentage is higher for infants younger than age 6 months. Infants are also more likely to suffer from such neurologic complications such as seizures and encephalopathy, probably due to the reduction of oxygen supply to the brain. Other less serious complications include ear infection, loss of appetite, and dehydration. Adults with pertussis can have complications such as pneumonia (up to 5% of cases) and rib fracture from coughing (up to 4% of cases). Other reported side effects include (among others), loss of consciousness, female urinary incontinence, hernias, angina, and weight loss.

According to the California Department of Public Health, about half of infants infected with pertussis get it from their parents, most often from their mothers. Even if parents and caregivers received pertussis vaccine when they were children, the immunity wears off. It is highly recommended that in addition to those for whom pertussis vaccine is already administered, parents and caregivers of infants receive Tdap, the booster shot against pertussis, preferably before contact with a new baby. 

According to the South Carolina Department of Health, everyone between the ages of 10 and 64 should be vaccinated against pertussis. Talk to your healthcare provider now to be sure you and your family are protected. Getting vaccinated is the best way to prevent the spread of pertussis. Some people with pertussis might not feel very sick and might not develop the coughing spells or ‘whoop,’ but they are still able to pass the infection to others. Seeking treatment when pertussis symptoms first start is important. If you or a family member are ill and worried about pertussis or have been exposed to someone with pertussis, contact your healthcare provider. Antibiotics can help prevent spreading the disease to people who have spent a lot of time around the infected person and are necessary to stop the spread of pertussis.

Antibiotics are somewhat helpful in treating pertussis. The drug of choice is usually erythromycin that is given to all household and other close contacts of the patient to minimize transmission, regardless of age and vaccination status, according to VaccineInformation.org. All close contacts younger than seven years of age should complete their DTaP vaccine series if they have not already done so. If they have completed their primary four dose series, but have not had a dose within the last three years, they should be given a booster dose. Patients also need supportive therapy such as bed rest, fluids, and control of fever. Reinfection appears to be uncommon but does occur. With natural infection, immunity to pertussis will likely wane as soon as seven years following the disease; reinfection may present as a persistent cough, rather than typical pertussis. Unfortunately, it is difficult to verify pertussis infection with existing laboratory methods.


Infants younger than 18 months need constant supervision because their breathing may temporarily stop during coughing spells. Infants with severe cases should be hospitalized. An oxygen tent with high humidity may be used. Fluids may be given through a vein if coughing spells are severe enough to prevent the person from drinking enough fluids. Sedatives (medicines to make you sleepy) may be prescribed for young children. Cough mixtures, expectorants, and suppressants are usually not helpful and should NOT be used, according to Google Health. Call your health care provider if you or your child develops symptoms of pertussis. Call 911 or get to an emergency room if the person has any of the following symptoms:
•Bluish skin color, which indicates a lack of oxygen.
•Periods of stopped breathing (apnea).
•Seizures or convulsions.
•High fever.
•Persistent vomiting.
•Dehydration.

DTaP vaccination, one of the recommended childhood immunizations, protects children against pertussis infection. DTaP vaccine can be safely given to infants. Five DTaP vaccines are recommended. They are usually given to children at ages 2 months, 4 months, 6 months, 15-18 months, and 4-6 years. The Tdap vaccine should be given around age 11 or 12, and every 10 years thereafter. During a pertussis outbreak, unimmunized children under age 7 should not attend school or public gatherings, and should be isolated from anyone known or suspected to be infected. This should last until 14 days after the last reported case. Some health care organizations strongly recommend that adults up to the age of 65 years receive the adult form of the vaccine against pertussis, according to Google Health.

Pertussis, or whooping cough, can be deadly. Make sure you and your children have been immunized, and keep up with booster shots at appropriate times. Staying healthy is in your best interest, and in the best interest, especially, for children and infants. Talk to your doctor for more details about this disease if you have questions or need help with a possible diagnosis. Don't get the "whoop."
 
Until next time. Let me know what you think.

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