Whooping Cough Health Article

Treatment

Treatment with the antibiotic erythromycin is helpful only at very early stages of whooping cough, during incubation and early in the catarrhal stage. After the cilia and the cells bearing those cilia, are damaged, the process cannot be reversed. Such a patient will experience the full progression of whooping cough symptoms; symptoms will only improve when the old, damaged lining cells of the respiratory tract are replaced over time with new, healthy, cilia-bearing cells. However, treatment with erythromycin is still recommended, to decrease the likelihood of B. pertussis spreading. In fact, all members of the household where a patient with whooping cough lives should be treated with erythromycin to prevent the spread of B. pertussis throughout the community. The only other treatment is supportive, and involves careful monitoring of fluids to prevent dehydration, rest in a quiet, dark room to decrease paroxysms, and suctioning of mucus.

Prognosis

Just under 1% of all cases of whooping cough cause death. Children who die of whooping cough usually have one or more of the following three conditions present:

• severe pneumonia, perhaps with accompanying encephalopathy
• extreme weight loss, weakness, and metabolic abnormalities due to persistent vomiting during paroxysms of coughing
• other pre-existing conditions, so that the patient is already in a relatively weak, vulnerable state (such conditions may include low birth weight babies, poor nutrition, infection with the measles virus, presence of other respiratory or gastrointestinal infections or diseases)

Prevention

The mainstay of prevention lies in programs similar to the mass immunization program in the United States which begins immunization inoculations when infants are two months old. The pertussis vaccine, most often given as one immunization together with diphtheria and tetanus, has greatly reduced the incidence of whooping cough. Unfortunately, there has been some concern about serious neurologic side effects from the vaccine itself. This concern led huge numbers of parents in England, Japan, and Sweden to avoid immunizing their children, which in turn has led to major epidemics of disease in those countries. However, several carefully constructed research studies have disproved the idea that the pertussis vaccine is the cause of neurologic damage. Furthermore, a newer formulation of the pertussis vaccine is available. Unlike the old whole cell pertussis vaccine, which is composed of the entire bacterial cell which has been deactivated (and therefore unable to cause infection), the newer acellular pertussis vaccine does not use a whole cell of the bacteria, but is made up of (between two and five) chemical components of the B. pertussis bacteria. The acellular pertussis vaccine appears to greatly reduce the risk of unpleasant reactions to the vaccine, including high fever and discomfort following vaccination.

BOOKS

"Pertussis." In Sherris Medical Microbiology: An Introduction to Infectious Diseases. 3rd ed. Ed. Kenneth J. Ryan. Norwalk, CT: Appleton & Lange, 1994.

Stoffman, Phyllis. The Family Guide to Preventing and Treating 100 Infectious Diseases. New York: John Wiley & Sons, 1995.

PERIODICALS

Jenkinson, Douglas. "Natural Course of 500 Consecutive Cases of Whooping Cough: A General Practice Population Study." British Medical Journal 310, no. 6975 (4 Feb.1995): 299+.

Rosalyn Carson-DeWitt, MD

KEY TERMS

Cilia—Tiny, hair-like projections from a cell. In the respiratory tract, cilia beat constantly in order to move mucus and debris up and out of the respiratory tree, in order to protect the lung from infection or irritation by foreign bodies.

Encephalopathy—Swelling and degeneration of the brain.