Are your children up to date on their pertussis immunization? How about you? Pertussis is a bacterium that causes whooping cough. It attacks the respiratory system and can be deadly to children 2 years old and under. This illness scares me. When I have a patient with this, I've been known to sit up all night at their bedside to make sure they keep breathing. I have toddlers in my practice that had whooping cough at 6-8 weeks of age, too young to be vaccinated. How does a child this young get exposed to pertussis, you ask? They get exposed through family members.
Vaccines work. We know this. However, their effectiveness wains over time. Many people haven't had a pertussis vaccine since 5 years of age. There is a relatively new vaccine on the market for teens and adults. Teens should receive this at age 10-11. Adults need to get this ASAP, then repeat it every 10 years. If you have a new baby, then mother, father, grandparents and older children all need to be up to date on their pertussis immunization before that baby comes home from the hospital. It could be lifesaving. Routine immunization and booster shots are important. Without a primary care physician and routine well visits, these things can be easily missed. I don't think there is enough being done to educate the public about this.
As doctors, we are taught that whooping cough is only a severe illness in small children. We are told that adults get a mild illness with a cough that lasts a month. Here is one family's experience with whooping cough. I would have trouble calling this a mild illness:
You asked for our family’s experience with pertussis last fall, so here goes. First, I should say we’re a family of four; our son Adrian is 30 and lives on his own, while our daughter Rachel, now 18, was living with us during her last year of high school here.
While health care is free in Canada, our much-loved family doctor had left his practice five years before, and we hadn’t been able to find an adequate replacement. During our search for a new doctor, when we needed health care, we relied on local walk-in clinics. The care there is good, and it’s covered by our health insurance, but unlike a family practice, there’s a lack of continuity. And treatment tends to be on a “per visit” basis, which means that ongoing health issues like vaccination schedules can be overlooked. By last fall, neither of the adults in the household had had DTP vaccinations for well over 10 years; Rachel had had one when she was 11, but was due for another; and Adrian hadn’t had one since his teen years. We later discovered that this left us all wide open to pertussis.
In September 2011, we attended an event at my father-in-law’s synagogue. Most of the guests were elderly, and we noticed that some had coughs or colds, but put that down to the season and their age. A week or two later, both Adrian and my husband Mitchell began coughing. Adrian’s cough was bad enough to keep him home from work, and he told us he’d been throwing up at the end of some coughing spasms. He’d cough for nearly a minute at a time, unable to catch his breath, and would eventually vomit or retch. We were quite concerned, and urged him to see a doctor. He did go to a clinic, where he was given a prescription cough suppressant. It did next to nothing, and eventually he asked Mitchell to accompany him to the ER at a local hospital, as he couldn’t control the cough and he was getting quite worried about it. In the ER, he was given a ventolin puffer and more cough suppressants, but no one mentioned pertussis.
Meanwhile, Mitchell had also been coughing severely enough that he pulled a rib out of alignment. He was lucky, though—his cough seemed relatively mild by comparison with Adrian’s, and it cleared up within about three weeks.
Next to fall was Rachel. As I mentioned, she’s had moderate to severe asthma since she was two years old, with multiple hospital admissions and visits to the ER. She’d been in the care of the respirology clinic at the local children’s hospital since she was about 12, and was doing pretty well on a combination of Alvesco, Advair, and ventolin. When she started coughing, it seemed like a mild cold at first, but as always, she upped her doses of preventive asthma drugs; but the coughing quickly escalated to the point where she was breathless and gasping, then vomiting at the end of each spasm. It was complicated, though, because she was also wheezing quite a bit. We took her to the ER twice in one week, and she was given large doses of ventolin, and sent home.
About a week into Rachel’s illness, I got it as well. (I should add that on September 28 last year I had a tib-fib fracture followed by emergency surgery, and was still in my cast, in a fair bit of pain, and unable to move much. Broken ankle + pertussis? Not a lot of fun.) As with Mitchell, Adrian, and Rachel, I found that the coughing would start to worsen in the evening, and would keep me wide awake most of the night. By morning it would start to ease up a bit, enough that I could grab a bit of sleep. Mine went on for about three weeks, and then started to improve.
At around the time that I started coughing, though, Adrian called me and said he was pretty sure we all had pertussis. I didn’t believe him at first—after all, isn’t that a rare disease that’s pretty much been eradicate? But he’d done his homework, and sent me to several online sources that seemed to confirm his suspicion. So after Rachel’s second hospital visit, when she kept getting worse, we took her back, and insisted that they do a swab for pertussis. The doctor on duty was very skeptical, and kept insisting that it was highly unlikely, and that the test was very uncomfortable, she wouldn’t like it, it wouldn’t tell them anything...but Mitchell politely insisted, and eventually they did the test. Two days later, the hospital called us back to confirm that Rachel had pertussis. And based on symptoms, so did the rest of our family.
Rachel and Adrian both continued coughing, though not quite as violently, well into the new year—the Chinese aren’t kidding when they call it the 100 Day Cough! Adrian missed about a month of work, and Rachel lost a good five weeks of he
r final year of high school. Fortunately, we’re all fine now, but it was a rough several months, and when I realized that it was basically because of our own ignorance, I was horrified. We strongly believe in vaccination, and would have had our shots if we’d known we were due for them; the main problem was just not knowing. Oh, and I should add that Mitchell, Rachel, and I have since found an excellent family physician that we all like; we’re hoping there will be room for Adrian in the practice in the next few months.
I hope this gives you a good picture of our experience, but if you have any questions, I’ll be happy to answer them.
Karen's experience highlights a number of issues:
1. Pertussis is still with us and whooping cough is still a problem.
2. Vaccines and immunization updates (booster shots) can fall through the cracks
3. It is important to have a primary care physician who oversees your healthcare
4. There is a huge need for vaccine education as a public health initiative.
Please stay tuned, as I will be bringing more information on immunization to my website in the next few months. You can also read more at Karen’s website: http://afterthekidsleave.wordpress.com/
~Dr Nan N~