health

1. Definition .
   
2. Description .
   
3. Demographics .
   
4. Causes and Symptoms .
   
5. Diagnosis .
   
6. Treatment .
   
7. Prognosis .
8. Prevention .
   
9. The Future .

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Whooping cough is a highly contagious and potentially fatal bacterial
infection of the upper respiratory tract.

Whooping cough, or pertussis, is a potentially severe upper respiratory
infection characterized by spells of intense coughing that end in a
whooping sound when the person is finally able to catch their breath.
It can affect people in any age group, but is most common (and most serious)
in infants and young children. The organism that causes whooping
cough affects only humans; it is not spread by animals.
The early symptoms ofwhooping cough resemble those of the common
cold—runny nose, sneezing, general unwell feeling—and the disease is
often mistaken for an ordinary cold. After about a week of cold-like symptoms,
however, the patient develops episodes of severe coughing that can
bring up thick phlegm (mucus) from the throat. The coughing may be
intense and spasmotic enough to cause vomiting or cause the patient to
turn red or blue in the face. At the end of the coughing attack, the patient
may make a whooping or crowing sound as they gasp to take in their next
breath of air.

At one time whooping cough was a leading cause of death in infants
and toddlers, causing 3,000 to 5,000 deaths in the United States
every year. Even though vaccines against whooping cough have been
available since the 1940s, the disease is still one of the leading causes
of vaccine-preventable deaths worldwide. The World Health Organization
(WHO) estimates that there are between 30 and 50 million
cases of pertussis each year around the world, and 300,000 deaths.
Ninety percent of cases of whooping cough occur in the developing
world. Widespread vaccination against the disease, however, has
lowered the death rate in the United States to fewer than thirty cases
per year.
In the United States, cases of whooping cough tend to cluster in
cycles, with peaks every three to four years. Outbreaks of whooping
cough are seasonal, with most cases occurring between June and September.
On average there are about 2.7 cases of whooping cough per
100,000 in the general population in North America.
Most people who get whooping cough in the United States are
unimmunized children or older teenagers and adults whose full immunity
has faded. The classic symptoms of whooping cough are not often
seen in this latter group, who are likely to have cough for more than
three weeks. According to the Centers for Disease Control and Prevention
(CDC), 29 percent of patients with whooping cough are younger
than one year; 12 percent are aged one to four years; 10 percent are aged
five to nine years; 29 percent are aged ten to nineteen years; and 20 percent
are older than twenty years.
As far as is known, males and females are equally affected by the disease.
Caucasians appear to be more likely to get whooping cough than
either African Americans or Native Americans.

Whooping cough is caused by a bacterium known as Bordetella
pertussis, an organism that appears to live only in humans.
The organism is spread primarily by droplets in the coughing
of infected individuals. When someone breathes in some of
these droplets, the bacterium attaches itself to the tissues
that line the throat and upper respiratory tract and multiplies.
The patient usually begins to feel sick within three to twelve
days after being infected.

The symptoms of whooping cough depend on the stage of the illness:

• Early phase (lasts one to two weeks). The patient appears to have
  an ordinary cold, with runny nose, sneezing, and nasal congestion.
  There may be low-grade fever and runny eyes. The disease is most likely
  to be spread to others at this stage.
  
• Coughing stage (one to two weeks). The patient has spells of intense
  coughing that may last for several minutes and end in a whooping sound
  as the child struggles for breath. Infants younger than six months do
  not usually make the whooping sound but may become completely exhausted.
  The child may turn red in the face and vomit at the end of the coughing spell.
  Adults with whooping cough may get headaches during this stage.
  The coughing is usually worse at night. In some cases the patient develops
  pinpoint-sized red marks in the upper chest or the whites of the eyes caused
  by the breaking of tiny blood vessels during the coughing spells.
  These little marks are called petechiae.
  
• Recovery stage (one to two weeks). The child begins to feel better
  but continues to cough occasionally
  

In most cases the doctor will make the diagnosis on the basis of the patient’s
physical symptoms, a history of exposure to others with whooping cough,
and the patient’s record of immunization against whooping cough. The
doctor may take a blood test to see whether the patient has a higher than
normal number of lymphocyte white blood cells or order a chest x ray to see
whether the patient has developed pneumonia, but neither of these tests is
specific for whooping cough. Tomake the diagnosis definite, the doctor can
take a sample of fluid fromthe patient’s nose or throat on a cotton swab and
send it to a laboratory for analysis.

Treatment of whooping cough depends partly on the patient’s age and
partly on the severity of the disease. Infants younger than six months
often need hospitalization so that they can be given oxygen, have mucus
removed from their airway, and fed intravenously if necessary. Very
young infants are at greatest risk of ear infections, seizures, or other complications
of whooping cough.
Older children, teenagers, and adults should stay home from school or
work in order not to give the disease to other people. They should rest in
bed if at all possible. In most cases the doctor will prescribe an antibiotic
medication, usually for two or three weeks. Antibiotics can shorten the
duration of the illness and also shorten the length of time that the patient
is contagious. In some cases the doctor will prescribe antibiotics for other
members of the patient’s family to reduce their risk of getting the disease.
Over-the counter cough medicines are not usually very helpful in
relieving the sore throat and coughing spells of whooping cough. A coolmist
vaporizer and drinking lots of fluids are usually more effective.

Older children, adolescents, and adults usually recover from whooping
cough in five to six weeks without any lasting effects. Infants who have
not been immunized against whooping cough and older adults with heart
problems or lung disease are at greatest risk of developing pneumonia or
other complications of whooping cough. About two-thirds of infants
who develop whooping cough will need hospital treatment; the average
length of stay for a baby with whooping cough in 2004 was seven days.
Of the deaths caused by whooping cough in the United States in the
early 2000s, 99 percent were in infants.

The best protection against whooping cough is immunization. Since the
1940s, the vaccine that protects against pertussis has been combined with
vaccines against diphtheria and tetanus in a single vaccine. The American
Academy of Pediatrics (AAP) recommends a total of five doses of the
combined vaccine in children between the ages of two months and six
years. Neither the vaccine nor getting the disease confers permanent
immunity against whooping cough, however; the effectiveness of the vaccine
fades away in three to five years after the last shot.
Because an increasing number of cases of whooping cough are being
diagnosed in teenagers, in 2005 the AAP recommended that all teenagers
receive an additional booster shot of vaccine. This measure is intended to
protect younger children as well as the adolescents, because the evidence
indicates that many cases of whooping cough in infants are caused by the
infection being transmitted to them by older family members. For adults
less than sxity-five years of age, one booster of whooping cough vaccine
should be given combined with the once every ten years tetanus/
diphtheria booster. This is especially important in prospective parents
and grandparents and those health care workers who work in pediatrics.

Whooping cough is likely to be a major public health problem even in
developed countries for the foreseeable future because of some people’s
opposition to vaccination. In the 1970s there were a number of lawsuits
filed by people who felt that they had been injured by the diphtheria/
tetanus/pertussis vaccine. While it was not clear in many of these cases
that the person’s health problems were caused by the vaccine, Congress
passed a law in 1986 that requires doctors to give a child’s parents an
information sheet about a vaccine before giving the child the shot. The
doctor is also required to report any side effects of the vaccination to a
national reporting system.
Vaccines licensed for use in the United States must go through a
three-stage process of clinical trials that often takes ten years or even
longer before the new vaccine is approved. A newer form of the
diphtheria/tetanus/pertussis vaccine was developed in 1991 and replaced
the older vaccine completely by 2002. It is reported to have lowered the
rate of side effects from vaccination in the United States by 90 percent.