By Kathy Swanwick Published: 2:00 AM – 03/02/11
As a young girl growing up in Iran, Dr. Minoo Pedoem-Shapiro witnessed the devastating effects of pertussis — also known as “whooping cough” — within her own family.
“I have seen it firsthand,” said Pedoem-Shapiro, now a pediatrician with new Windsor Pediatrics. “My cousin died of pertussis, back in my country.”
“I was maybe 10 years old and he was maybe 2, 3 years old,” she said recently.
• Pertussis is also known as “whooping cough” because of the “whooping” sound that is made when gasping for air after a fit of coughing.
• In the United States in 2009, nearly 17,000 cases of pertussis were reported, but many more went undiagnosed or unreported.
• Since the 1980s, there has been an increase in the number of reported cases of pertussis in the U.S., especially those ages 10-19 and infants under 6 months.
• Reports of pertussis vary from year to year but tend to peak every 3-5 years. this pattern is not completely understood. The last peak in the U.S. was in 2005, when more than 25,000 cases were reported.
• The most effective way to prevent pertussis is through vaccination with DTaP for infants and children, and with Tdap for preteens, teens and adults, as immunity from the childhood vaccine fades over time.
• Vaccinated children and adults can become infected with and transmit pertussis; the disease, however, in older children and adults is likely to be less severe.
• Vaccination of preteens, teens and adults with Tdap is especially important for families with newborns.
• Pertussis is generally treated with antibiotics, which are used to control the symptoms and to prevent infected people from spreading the disease.
• Coughing fits from pertussis infection can last up to 10 weeks or more; hence, pertussis is sometimes referred to as the “100-day cough.”
Source: Centers for Disease Control and Prevention
An ailment that gets its nickname from the distinctive “whooping” sound that some patients make as they gasp for air following a coughing fit, pertussis is a very contagious disease spread person-to-person by coughing and sneezing.
At the time, said Pedoem-Shapiro, vaccinations in her native country were scarce, and childhood mortality from now-preventable diseases was high. Her own brother had died of polio nearly a decade earlier, when she was just an infant.
When her cousin became ill, Pedoem-Shapiro was old enough to see the awful consequences of the disease, which could have been prevented through vaccination.
“In those years we were not so advanced; I’m talking maybe 50 years ago,” Pedoem-Shapiro said. “I saw my cousin with encephalitis. and they told me he had the symptoms of whooping cough. and I remember the coughing. I remember his fever, high fever. Sometimes patients get bronchial pneumonia and then the high fever, and then sometimes they can get the severe encephalitis. That’s what my cousin had. there was no treatment, nothing. there was no antibiotic. he had encephalitis, and he passed.”
Pedoem-Shapiro tells her family’s painful history to illustrate the importance of vaccines as pertussis — a disease once thought to be nearly eradicated — makes a comeback in the United States.
Last year, in California alone, there were more than 8,000 confirmed cases of whooping cough. According to the new York state Department of Health, 265 cases of pertussis were confirmed in new York in 2009, with a preliminary number of 731 cases reported in 2010. last year’s numbers are still being investigated.
“It’s a dangerous illness in infants, mostly in those under 6 months,” said Dr. Paul mark Baker, a pediatrician with Hudson Valley Pediatrics in the Town of Wallkill.
“They have a 1 percent chance of dying. They’re the ones we’re trying to protect.”
Those very young infants are most at risk because they cannot be given even the first dose of the vaccine until they are 2 months old. by 6 months they will have received the third of the five recommended doses, the last coming between ages 4 and 6.
“They’re the most susceptible early on,” said Baker.
There has been a steady increase of reported cases of whooping cough since the 1980s, according to state and federal agencies.
And over the past five years, according to the Centers for Disease Control and Prevention, there have been between 8,000 and 25,000 cases reported each year. Reports of pertussis vary from year to year but tend to peak every 3-5 years. The last peak year was 2005, when 25,000 cases were reported — the highest number since 1959, according to the new York state Department of Health.
There are a number of reasons for the increase, experts say.
Many adults and adolescents who were vaccinated years ago, according to the new York state Department of Health, may have lost their immunity and need booster shots. a new single booster vaccine, Tdap (tetanus, diphtheria and acellular pertussis), was approved in 2005 to provide immunization for that segment of the population.
And some parents are reluctant — or refuse — to have their children vaccinated out of fear or opposition to vaccines. Some believe, according to the CDC, that vaccine-preventable diseases do not pose serious health risks; others object on religious or philosophical grounds. Others express concern about the safety and efficacy of the vaccine.
“Some families just don’t want to have their children immunized,” said Baker.
In new York state, however, according to the Health Department, pertussis vaccine is mandatory for all children born after Jan. 1, 2005, who will be attending pre-kindergarten programs and school. and Tdap, the booster, is required for all children born after Jan. 1, 1994, and entering the sixth grade.
Immunization, said Baker, begins to wear off after about five years, which is why a booster is given at about age 11. It is also why adolescents and adults should talk to their doctors about getting a booster — or being vaccinated for the first time, if necessary.
“Adults are the reservoir of whooping cough,” said Baker, noting that he has not seen a case lately in his practice. “Adults do not get terribly ill. but the probability is that they’re contagious and they can bring it home to their 2-month-old baby.”
“We are seeing more, especially in adults,” said Pedoem-Shapiro, noting that she has had the booster herself. “The young mothers, they really should have the vaccine.”
Whooping cough progresses in three stages, and can last up to 10 weeks.
The first stage presents like the common cold and lasts for one to two weeks. At this point, the person is the most contagious.
The “paroxysmal” stage is next, characterized by coughing fits followed by the “whooping” sound, and oftentimes, vomiting and exhaustion. this stage can last for 1-6 weeks, according to the CDC — even up to 10 weeks.
“It’s a fairly dramatic cough that comes in spasms,” said Baker.
“It’s very characteristic,” said Pedoem-Shapiro. “They can have fever and severe cough and the cough is so severe they throw up. and they can make a noise like a whooping. and they get cyanotic (skin turns bluish because of lack of oxygen in the blood). and then they get better. and then they cough again, and they have runny nose, they have fever and the cough. The fever can get so high, and one of the complications of pertussis is pneumonia. They can get encephalitis — swelling of the brain.”
Not everyone, however, has the distinctive cough, and most people do not become that ill.
The convalescent stage follows, during which time the cough lessens but may return, and lasts for about 2-3 weeks.
Whooping cough, said both local doctors, often goes undiagnosed and goes away on its own, after weeks of an annoying, lingering cough.
“A person can indeed have pertussis and not know it,” said Baker. “This is especially common in adults, since they may only have a prolonged cough illness.”
Doctors can test for pertussis with a nasal swab and treat the disease with antibiotics. Baker also recommends vaccinations for all family members and caregivers in households with infants.
The vaccine, he said, prevents 98 percent of serious illness from the disease. and side effects of the vaccine, which he has given every day for the past 20 years, are minimal.
“There is usually no reaction at all,” he said, “but sometimes there can be mild fever, irritability or swelling at the shot site. Rarely, there can be high fever or persistent crying.”
Pedoem-Shapiro promotes wellness programs in her practice and encourages families to take somewhat holistic approaches to health and medicine in general. She knows some parents are reluctant to give their children vaccines, and she works with them as gently and compassionately as possible to convince them of the vaccines’ vital roles.
“I am very careful not to push medications,” she said. “But I am very pro-vaccine because I have seen in the firsthand all these diseases. The Americans are very lucky, and they haven’t seen these diseases. I think this is what triggered me to be a pediatrician, actually. I have seen the worst of these diseases.”
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