When Avery Holdsworth was 3 months old, she began coughing so hard that "she would almost lift her little body off the crib mattress," remembers her mother, Amanda Holdsworth of Howell, Michigan.
When she wasn't coughing, which was most of the time, Avery looked fine. And she didn't have a runny nose or a fever. However, the cough was so severe that Holdsworth took her daughter to the pediatrician three times in 10 days. The doctor ruled out RSV (respiratory syncytial virus) and allergies, but the cough continued. Finally, Holdsworth's husband suggested having Avery tested for pertussis because a client's child had recently been diagnosed with it.
"I said, 'Whooping cough? Isn't that like a Little House on the Prairie disease?'" recalls Holdsworth. She was shocked when Avery tested positive.
Whooping cough (pertussis) is a very contagious infection of the upper respiratory tract caused by the bacteria Bordetella pertussis. The infection is spread through sneezing, coughing, and direct contact with infected secretions such as saliva and mucus. The incubation period can last 5 to 21 days, but usually for about a week. Once upon a time, it was as dreaded a disease as polio, says Parents advisor Harley Rotbart, M.D., professor of pediatric infectious diseases at the University of Colorado School of Medicine.
Today there's a vaccine, but whooping cough epidemics still occur in cycles and tend to peak roughly about every three to five years, explains Ari Brown, M.D., author of Baby 411: Clear Answers & Smart Advice for Your Baby's First Year. The last major epidemic was in 2014, when the state of California saw 800 cases in two weeks, so the U.S. is likely to see an uptick in infections soon.
Pertussis outbreaks happen because of what some experts call a perfect storm of innocent ignorance, anti-vaccine sentiment, and less-than-perfect immunizations. In 2012, more than 41,000 confirmed cases of whooping cough were reported to the Centers for Disease Control and Prevention (CDC)—the most since 1955. (That number dropped to just under 18,000 in 2016.)
"That's likely just the tip of the iceberg," says Mary Anne Jackson, M.D., section chief of infectious disease at Children's Mercy Hospital in Kansas City, Missouri. "Many cases go undiagnosed and many don't get treated with antibiotics, so the disease continues to spread." Babies are at highest risk of getting pertussis and becoming dangerously ill, but more school-age children are getting sick than ever before too.
One of the biggest dangers of the disease is that it is often not diagnosed until it has progressed to a more serious stage, when breathing becomes difficult. At that point it's easy to develop respiratory infections like pneumonia. "Children can literally suffocate because they cannot catch their breath. Their cough and whoop can be so severe that they die of oxygen deprivation," Dr. Rotbart explains. Understanding the facts about the disease known as "the 100-day cough" will go a long way to helping prevent it.
The disease starts with cold-like symptoms including mild coughing then, following the onset of symptoms in the first week or two, the cough becomes more pronounced with frequent coughing fits, especially at night. Here's what to watch for:
Even though more older kids are getting whooping cough now, babies are still at highest risk. Every year in the U.S., between five and 15 babies die of whooping cough, according to the CDC.
Infants in their first year of life are the most likely to be admitted to the hospital with whooping cough and to develop serious complications like pneumonia. Some experience temporary loss of breath instead of coughing fits, and the temporary loss of oxygen can cause the skin color to turn bluish—as seen in this video of a 4-month-old with whooping cough. In very rare cases, whooping cough can cause seizures and brain damage in newborns and infants.
When infected babies don't eat or drink enough, the coughing fits and whooping can be accompanied by vomiting.
Look out for these dangerous signs of dehydration:
Outbreaks of this vaccine-preventable disease don't happen simply because some parents choose not to vaccinate their kids. "It would be terrific if 100 percent of children were vaccinated, but it's not that simple a solution," says Dr. Brown. "Infectious diseases are much more complex."
To start, babies cannot receive their first vaccination for whooping cough until they are 2 months old. "Even then, they do not have adequate immunity until they have received at least three doses of whooping cough vaccine DTap, at 6 months," says Dr. Brown. In other words, babies rely on those around them to be protected by vaccination and not spread the infection to them. According to Dr. Brown, up to 80 percent of babies get whooping cough from a loved one in their household—most often their moms.
Adults often don't know they have the illness, which can look like a common cold at the beginning of the infection. Then it becomes a cough that just lingers (whooping cough is also known as the "100 Day Cough"). People are contagious up to about two weeks after the cough begins.
Plus, immunity to whooping cough does not last forever—even if you are vaccinated for protection or you had the disease before. Immunity wears off over time (listen up, adolescents and adults!). That's why it is so important to get the whooping cough booster vaccine, called Tdap (for tetanus, diphtheria, and pertussis).
Make sure your child is up to date on his shots and make sure you are, too. In the U.S., the whooping cough vaccine—diphtheria, tetanus, and pertussis (DTaP)—is administered as part of the recommended immunization schedule for children at least five times: three times each at 2, 4, 6 months, once between 15 and 18 months, and once between 4 and 6 years old.
To protect a young baby, experts recommend a "cocooning" strategy. This means parents should get the Tdap booster and all siblings should be vaccinated, as should anyone who will be around the baby—child-care providers, aunts, uncles, friends, grandparents. (Unsure if you've had Tdap—or DTaP? Check with your doc. Many adults mistakenly assume they're protected.)
Teens, beginning at 11 to 12 years of age, and adults can receive a whooping cough vaccine called Tdap. "If you can't remember the last time you got your tetanus shot, you need get the Tdap vaccine," says Dr. Brown.
These are the latest recommendations from the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP):
1. Adults ages 65 and up should get Tdap if they will be around infants who are younger than 1 year of age. (Previously, only those ages 64 and younger were advised to get the vaccine.)
2. Adults ages 65 and up can get Tdap as their tetanus booster if they have never received Tdap before.
3. Adults who've had the Tdap vaccine should get a booster shot of tetanus and diphtheria toxoids (Td) vaccine every 10 years (or earlier needed for wound management).
4. Pregnant women should get Tdap sometime between 27 and 36 weeks, regardless of whether they've had the vaccine before or not. This way, a mom passes immunity on to her baby, which offers some protection until he starts getting his own vaccines at 2 months. A 2017 study by the CDC found that the Tdap vaccine in pregnancy prevented most cases of whooping cough in newborns.
5. Healthcare professionals who have direct patient contact with babies younger than 1 year of age should get Tdap.
"Many adult medical practices do not stock the Tdap vaccine, but ask for it and your doctor may get it for you," recommends Dr. Brown. "If you cannot get it from your doctor, call around to your local pharmacy or even grocery store, if it has a pharmacy department."
Always consult your pediatrician, who will prescribe antibiotics that will treat the whooping cough for up to two weeks. (Cough syrups are rarely effective.) The doctor may also give extra oxygen, suction mucus from the respiratory tract, or give intravenous fluids if your child is dehydrated.
At home, a humidifier or cool-mist vaporizer can ease the child's discomfort. Make sure your child is not exposed to aerosol sprays, tobacco smoke, or other substances that can irritate the respiratory passages. To prevent dehydration, give plenty of fluids and, when appropriate, nose drops.