askthedoctor Pertussis T

Get Vaccinated Vaccination is the pri- mary prevention for per- tussis, both for infants and adults. The vaccine also is recommended for pregnant women late in their pregnancies, to pro- vide protective antibodies to their infants. Talk with your health care provider about whether you need a booster shot.

46 MILITARY OFFICER FEBRUARY 2015

Vaccination dramatically reduced the incidence of pertussis, or whooping cough. Now, however, the disease is reemerging in teens and adults. By Rear Adm. Joyce Johnson, D.O.

Though pertussis affects people of all ages, it is especially dangerous for infants. Before a vaccine became widely available, there were about 200,000 cases in children each year, with 9,000 deaths. Vaccination reduced its incidence in infants and young children, but as these infants become teens and adults, their immunity is waning, and the disease is reemerging. Each year in the U.S., more than 10,000 cases of pertussis are reported — up to 40,000 some years — with 10 to 20 deaths. However, preventive action can reduce disease. Pertussis is caused by the bacterium

Bordetella pertussis. It can be transmit- ted when an infected person coughs or sneezes and someone nearby inhales the bacteria. The bacteria enter and attach to the upper airway, where they grow and release toxins causing infl ammation and swelling that lead to a cough. Pertussis also is called whooping cough due to the severe cough it causes. Extended coughing spells can lead to vomiting and ex- haustion, even fracturing ribs in teens and adults. Patients often don’t have time to in- hale between coughs; when they do breathe in, it is a deep but quick breath, with a “whoop” sound throughout the inhalation. Pertussis can last three or more months — in China, it’s known as the “100-day cough.” Adults can have pertussis and spread it to others without knowing. The time from exposure to symptoms is usually about seven to 10 days, though it can take up to six weeks. The fi rst symptoms, in what is

known as the catarrhal stage, last a week or two and resemble a cold: slight fever, runny nose, and minimal cough. Infants can expe- rience apnea (short periods where breath- ing stops). The next stage, the paroxysmal stage, includes serious, prolonged coughing spells and can last up to 10 weeks. Weight loss is common, as coughing interferes with eating. Recovery, the convalescent stage, is gradual; coughing lessens over a span of two or three weeks. Those vaccinated as infants might get a less severe form of the disease. Even today, it is fatal in nearly 2 percent of infants hospitalized with it. Pertussis is treated with antibiotics and supportive care. Treatment not only helps the patient’s health but also reduces trans- mission to others. Start antibiotics early; after about three weeks of illness, the bac- teria usually are gone and antibiotics have little impact. A patient might continue to cough and have other symptoms due to un- derlying lung infl ammation and damage. Neither vaccination nor having pertussis

provides lifelong immunity. Those in close contact with a pertussis patient might be prescribed preventive antibiotics. Good hy- giene — washing your hands, covering your mouth and nose when coughing, etcetera — are important to minimize the transmission of whooping cough and other diseases.

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— Rear Adm. Joyce Johnson, USPHS (Ret), D.O., M.A., is a health care consultant in Chevy Chase, Md. Find more health and wellness resources at www.moaa.org/wellness. For sub- mission information, see page 6.

PHOTO: STEVE BARRETT