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Pertussis–What’s the Big Whoop?!

Pertussis, known more commonly as Whooping Cough, has reached epidemic levels in Washington State, where I live and practice. Some people may wonder what this means to them. Attitudes about this particular disease can vary greatly represented bythe following range of questions: Isn’t this a treatable illness? Should we all be wearing masks in public? What’s the big deal? Isn’t this just another example of media hype? How can anyone choose not to vaccinate their children or themselves? Do I really need the booster vaccine? Does my child really need the booster vaccine? Should I go to the doctor for my cough? Aren’t there risks with the vaccine? Do people really die from pertussis?

Please continue reading if you are interested in factual and practical information about Pertussis, including what you should do to protect yourself and family if you are not vaccinated against this highly contagious infection. The more educated we are, the more likely we will be to take measures that stop the spread of this disease.

Pertussis is a respiratory infection caused by the bacteria, Bordetella pertussis. It is also known as Whooping Cough or the 100 days cough. In infants and young children, it presents as a bad cough with a telltale inspiratory whoop. The cough may also be followed by gagging or vomiting. Before the bad cough starts, those infected may have a slight fever, runny nose, sneezing, mild cough, and nasal discharge. These symptoms are often passed off as an ordinary cold, which is part of the reason this spreads so quickly. Imagine how many people could be infected if you or your child go about your normal business while you have these mild symptoms. Since the incubation period for pertussis is 7-10 days, it is possible to spread the illness for over a week before you even realize you have it! This is one of the reasons it has reached epidemic levels again in Washington. People are spreading it rapidly through schools, churches, daycares and healthcare settings largely because they don’t realize they have such a potentially serious infection. So far in 2012, there have been over 600 reported cases of pertussis in Washington. Last year, there were 965 cases for the whole year and fewer than 100 cases in the same time period last year. This represents a significant increase and cause for concern. The Secretary of Health,  Mary Selecky, said in a statement to the press last week that “If this rate were to continue, we would be seeing cases in numbers that have not been seen in this state since 1942.”

Some may wonder why we should be so alarmed if we now have antibiotics that can treat this illness and vaccines available to prevent it. The bottom line is that pertussis is deadly in the most vulnerable of our population and there have already been 4 infant deaths in the past year resulting from this infection. This is simply unacceptable in an age where we have the knowledge and technology available to prevent this illness from spreading and the unnecessary deaths that occur when epidemic levels are reached. Vaccines are one way to prevent the spread of this illness. The CDC recommends a series of DTaP injections for infants and children at ages 2, 4, 6, and 15-18 months with an additional booster given at ages 4-6 years. In addition, a Tdap injection is recommended for older children at age 11-12 and as the preferred Tetanus booster for adults every 10 years. Pregnant women may receive the Tdap vaccine after 20 weeks of gestation if their booster status is unknown–alternatively, they may defer the booster until after giving birth. Healthcare providers and those in close contact with infants and immune compromised individuals should also make sure their booster is up to date by getting a Tdap injection. Many people mistakenly believe that the DTaP vaccine is dangerous to give to infants because of a history of adverse events reported after children received the older version of the vaccine, the DTP. Unlike the DTP, the DTaP contains acellular pertussis, which is much less likely to cause serious adverse events; however, the protection against pertussis is not as great with this version of the vaccine, which is why it is important for children and adults to be fully vaccinated and up to date on their boosters. DTaP has been available since 1992 and adults who may have reacted to the old version are still encouraged to get a booster with the Tdap but should talk to a healthcare provider first to discuss individual risks.

Being a Naturopath, I routinely counsel parents seeking alternate and/or delayed vaccine schedules for their infants and children. Parents are generally concerned with the number of vaccines given to infants at such a young age. When it comes to pertussis antibody protection, I recommend following the CDC guidelines for vaccination. My reasoning is simple–this illness is quite serious and possibly deadly in young infants and antibody protection for pertussis is not passed through breastmilk as readily as antibodies for other vaccine preventable diseases. The risks of the vaccine are far less than the consequences of being unvaccinated, especially considering the prevalence of this illness. I counsel parents who choose not to vaccinate their infant for whatever reason to consider getting the Tdap booster themselves as well as have siblings who may be in school or daycare receive the appropriate vaccines in order to prevent infecting the baby. Babies who are not vaccinated should be kept away from people and places where they may be exposed to this illness. Anyone with a cough should not be allowed near an infant unless they are a parent or guardian, in which case they must take extra precautions (frequent hand washing, wearing a mask, if necessary) to avoid infecting the baby. I also counsel all of my unvaccinated patients on immune supportive measures since having an optimally functioning immune system is the surest way to avoid getting sick. Individual recommendations may vary, so I suggest seeking the expertise of a Naturopath rather than give blanket recommendations. Among the things I recommend are adequate sleep, proper nutrition, hydration, probiotics, supplementation to treat and prevent key nutrient deficiencies or inadequacies, and practicing good hygeine!

What if you think you have pertussis? You should immediately call your healthcare provider and make sure you notify them if you believe you may have pertussis. Some doctors may be able to offer advice and/or call in a prescription if you have the symptoms and were exposed to someone with a confirmed case. This method of treatment prevents you from having to make a trip to a doctor or hospital where you could potentially infect other people. If you have symptoms but no know exposure to someone with pertussis, you may need to be tested. In Washington state, pertussis is reportable disease, meaning that healthcare providers are required to report lab confirmed cases, so that the Public Health department can do their best to track and prevent the spread of this disease. The lab test involves inserting a special swab up through the nose until it touches the back of the throat. It can be uncomfortable for infants and young children, so is best done in a setting experienced with doing these on young patients (such as a pediatrician’s office, Children’s Urgent Care, or Children’s Hospital). Here in Washington, the Seattle Children’s hospital lab also has the ability to get same day results, whereas the other lab providers often take 2-3 days. Most doctors will prescribe an antibiotic if symptoms are present even before a case is confirmed. The typical antibiotic prescribed is Azithromycin, since it requires only a 5 day treatment course, but other antibiotics may be preferrable in some cases.

Although pertussis is treatable with antibiotics, a concern with becoming complacent about prevention is that antibiotic resistance may develop, creating a much more serious problem. Even with antibiotics, the symptoms and cough can persist for several weeks. A person taking antibiotics is considered no longer contagious after 5 days of treatment. It is always important to take the full course of an antibiotic treatment as prescribed and call your provider immediatly if you have an allergic reaction or intolerance to the medication. You may be given a different antibiotic in these cases. I routinely prescribe and recommend probiotics every time I prescribe antibiotics for patients. If your healthcare provider does not have a recommendation for you, pharmacists are a great resource and can often help you find a high quality probiotic to take during and after your antibiotic course. You should take probiotics away from antibiotics (at least 2 hours after a dose or 1 hour before) for best results. I also recommend taking probiotics for 3-4 weeks following a course of antibiotics to prevent digestive side effects.

As a way of preventing the spread of this disease, prophylactic antibiotics may also be prescribed to family members and close contacts of patients with confirmed cases of pertussis. Unvaccinated children may also be told to stay home from school or daycare during an outbreak (and for up to 14 days after last reported case) unless their vaccine status is up to date. It is important to follow the recommendations made by Public Health in these circumstances in order to avoid spreading this disease unnecessarily. If you choose not to follow these guidelines, you may be putting the health of others at risk! Naturopathic doctors are often more willing to discuss alternatives for those who have philisophical objections to the conventional prevention and treatment methods, but even in my practice, I prefer to have this discussion in the context of what can be done to prevent the disease rather than what can be done to treat it. Ultimately, this will result in decreased spread of disease and an overall decreased need for antibiotics–a win-win in my book!

Here are some links for more information about pertussis:

www.soundsofpertussis.com

http://www.cdc.gov/pertussis

http://www.doh.wa.gov/EHSPHL/factsheet/pertussis.htm

http://children.webmd.com/tc/whooping-cough-pertussis-home-treatment

http://www.youtube.com/watch?v=3LsuJi33B2U

 

About the Author: Dr. Bowker is a Naturopathic Physician and owner of Snohomish Valley Holistic Medicine. In addition to her clinical practice, Dr. Bowker serves as a Board member for the Washington Association of Naturopathic Physicians. She has also been a guest speaker for community organizations and instructor of several community health classes. For more information, please visit her primary website: www.snovalleyholistic.com

 

 

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