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When I was a toddler nearly 60 years ago, I survived a brush with whooping cough. Vaccination programs seemed to have made the once-deadly disease a thing of the past, but an unexpected failure of vaccination is allowing whooping cough to make a comeback.

Back in the 1950's, I came down with a really nasty infection I remember vividly, even though I was only about two years old. In the front room of my grandmother's house in Augusta, Georgia, I coughed and coughed and coughed, so sick that I had forgotten that Santa Claus was due to arrive any day. I don't know from my own recollection whether I "whooped," making the unmistakable sound of struggling to breath through passages that are partially closed, but I do know I had to stay by myself, away from my aunts and my uncles and my grandpa and my grandma until I got better.

I had whooping cough. Just a few years later, whooping cough became a memory as school children were required to take vaccinations to prevent the disease. However, in recent years  the sometimes deadly respiratory infection has made a resurgence as vaccinations are no longer completely effective.

What Is Whooping Cough?

Whooping cough, also known as pertussis, is an infection with the bacterium Bordetella pertussis or Bordetella parapertussis. This bacterium has to have oxygen to live, preferring lung tissue, and is "fastidious," meaning it is hard to grow in a test tube, and does not need to form a film with other bacteria to attach itself to the linings of the lung. This microbe causes whooping cough in humans and a disease called kennel cough in dogs. 

Whooping cough is extremely infectious. From 80 to 90% of people who are exposed to the germ develop the disease. Epidemics of whooping cough are most common in late summer to early winter, lingering longer in more southerly locations.

The Catarrhal Phase

The early stages of whooping cough are hard to distinguish from common cold. There can be runny nose, mucus under the eyelids, a slight fever, and sneezing. During this stage, the disease is particularly infectious, spread from person to person by contact with mucus or droplets in the air after a sneeze. The disease continues to be infectious for up to 3 weeks after cough has begun.

The Paroxysmal Phase

Several weeks after the infection becomes obvious, it may cause unremitting cough. In infants and toddlers the air passages are smaller, so that inflammation may cause them to partially close. Constant coughing leads to red eyes and exhaustion, and in the very young and, oddly enough, in adults aged 45 to 64, it may also cause pneumonia.

The Recovery Phase

After several weeks, constant cough stops, and frequent, dry, nonproductive cough may continue for several weeks more.

Who Gets Whooping Cough/Pertussis?

In the United States, pertussis used to strike about 250,000 people a year, killing about 10,000. After vaccinations became commonplace, the infection rate fell to as low as 1010 in 1976, but soared to 27,560 cases in 2010. Deaths from the disease in the twenty-first century are fewer, but the infection still strikes infants and toddlers (about 35% of cases in the US), children aged 7 to 10 (about 17% of cases in the US) who pick up the infection at school, and teens and adults of all ages. At least 90% of deaths from the disease occur in infants under the age of six months.

What Went Wrong With The DPT Vaccine, And What You Need to Do 

For several decades, nearly every school child was given a diphtheria-pertussis-tetanus vaccine, and all three diseases became very rare. There were no widespread epidemics of pertussis/whooping cough for many years. One shot offered protection from diphtheria for at least 10 years, although the "whole cells" of the diphtheria bacterium used to make the vaccine sometimes caused pain and redness at the injection site. To avoid discomfort from vaccination, public health officials in Japan started using an "acellular" pertussis vaccine, made with pieces of the bacterium, in the early 1980's. American public health officials started using the more expensive, Japanese vaccine about 1995.

And epidemics of whooping cough started about 5 years later. Scientists now know that the "acellular" vaccines that don't carry a high risk of inflammation--when I was in the first grade, most kids who got the shot had sore arms for several days--also don't offer long-term protection. Children who were assumed to be not at risk for getting the disease catch it in their kindergarten or elementary school classrooms, and adults whose lungs are sufficiently well developed that they don't show symptoms can give the infection to vulnerable infants, toddlers, and children without even knowing they have it.

Not Just a Problem of Vaccine Avoidance

Children whose parents do not allow them to get vaccinations, of course, can catch infections they pass on to other children. At first, scientists believed that the recent surge in pertussis infections was due to vaccine protestors. As researchers at the Office of Vaccines Research and Review in the Food and Drug Administration took a closer look at their data, however, they found that the problem was with the vaccine itself.

Newly vaccinated children don't get symptoms when they contract the whooping cough bacterium, but they can spread the disease to others. Children who are not vaccinated can actually catch the disease from children who are.

Read More: Pertussis Vaccine: DTaP Vaccination Protects Children Against Diphtheria, Tetanus, and the Bacteria

So, What Should Parents Do?

There are two ways to prevent infection in a child or yourself. One is to get the vaccine, but to get it in the later winter, spring, or early summer, so your immune system can build up enough resistance to the diphtheria "bug" that you won't pass it on to others. Then it is necessary to get revaccinated about every three years to keep up your immunity. 

Or, if you choose not to have your children vaccinated, then you need to take careful measures to make sure they do not come in contact with the sneeze spray or mucus secretions of other children, or spread their own sneeze spray or mucus secretions to their classmates and playmates. This means teaching your children to cover their mouths and noses when they sneeze, and to wash their hands with warm water and soap frequently during the day, even when they "don't need to." Picking nose buggers has to be an absolute no-no, especially during the months the bacterium can go around.

The new vaccines are free of mercury compounds that once caused considerable alarm. They are unlikely to cause pain or swelling in the arm that receives the injection. And they are available for free at most public health offices. Resign yourself to a program of comprehensive personal hygiene, or get vaccinations for your kids--and yourself--today.

Read full article

  • Brown T. Pertussis vaccines: whole-cell more durable than acellular. Medscape Medical News [serial online]. May 22, 2013.
  • Walsh PF, Kimmel L, Feola M, Tran T, Lim C, De Salvia L, et al. Prevalence of Bordetella pertussis and Bordetella parapertussis in infants presenting to the emergency department with bronchiolitis. J Emerg Med. Mar 2011. 40(3):256-61.
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