Posted on 02/26/2005 7:00:46 PM PST by neverdem
For six months last year, Jill Wilson had a persistent cough. "It was so harsh and deep that I broke ribs," she said.
Various medical specialists told Ms. Wilson, an otherwise fit 60-year-old, that she had bronchitis, asthma, allergies and perhaps even a serious lung disorder known as interstitial pulmonary fibrosis.
"All wrong," said Ms. Wilson, a retired president of a real estate management company who lives in San Antonio.
It wasn't until she saw an infectious disease expert that Ms. Wilson learned that she had pertussis, or whooping cough.
Commonly thought of as a childhood illness controlled by routine vaccination, pertussis is a growing health threat in the United States. The incidence is highest among adolescents and adults, who are often unaware that they have the highly communicable, debilitating and sometimes deadly disease.
According to the Centers for Disease Control and Prevention, there were 18,957 reported cases of pertussis in the United States in 2004, up from 9,784 in 2003.
"It's a big jump," said Dr. Margaret Cortese, a medical epidemiologist with the C.D.C.'s National Immunization Program, compared with the more gradual increases that have occurred since the 1980's, when the average annual total was 4,400.
Explanations for the trend include declining vaccination rates, more travel related exposures and better diagnostic tests. But Dr. Cortese said the most likely reason for the increase last year was that "the pool of susceptible people has built up so that it only takes one sick person to start a serious outbreak."
The protection offered by the pertussis vaccine, which is usually given in five doses to children under 7, lasts only 5 to 10 years. Immunity is prolonged if vaccinated individuals are somehow exposed to the whooping cough bacterium, known as Bordetella pertussis. This is a bit like getting an airborne booster shot.
Repeated unwitting exposures could theoretically protect a person from getting whooping cough for life. But this creates fewer potential carriers of the disease and fewer opportunities for contact. The eventual result is a vulnerable population, which is what experts think is responsible for the current epidemic.
No pertussis vaccine has been approved for adolescents and adults in the United States. Sanofi Pasteur and GlaxoSmithKline, however, have each petitioned the Food and Drug Administration to market such formulations, which are already available in Europe.
"What we're really dealing with here is waning immunity," said Dr. Jeff Davis, chief medical officer with the Wisconsin Division of Public Health.
With 5,162 reported cases of whooping cough last year, Wisconsin had the worst outbreak in the nation. "The disease puts tremendous pressure on state health departments," Dr. Davis said.
Once a case is reported, health officials must investigate who had close contact with the ill person so he or she can be put on preventive antibiotics and possibly be quarantined for five days before returning to school or work.
In November, after doctors determined that her 15-year-old daughter, Samantha, had pertussis, Mary Sigman of Ottumwa, Iowa, was quarantined. So were many of her daughter's classmates. And the eight relatives who shared Thanksgiving dinner with Samantha had to take a course of antibiotics. "We also had to notify all my co-workers," said Ms. Sigman, who is an assistant manager at a bank. "It was a total nightmare."
Health officials say such an aggressive response is primarily to prevent transmission of the disease to infants, who are not old enough to be fully immunized and are most at risk of dying from pertussis.
Indeed, 19 of the 20 deaths attributed to pertussis in this country last year were infants. Whooping cough was one of the leading causes of infant mortality before the vaccine was introduced in the 1940's, and it still kills almost 300,000 children annually worldwide. Although pertussis usually is not life threatening for adults, it is still a "nasty infection that lasts months and has a tremendous impact on productivity because people have this awful cough and can't sleep," Dr. Davis said.
Pertussis starts much like a common cold, with a runny nose, sneezing and perhaps a mild fever and occasional cough. After a week or two, the disease progresses to a phase characterized by coughing fits, sometimes punctuated by a loud gasp for breath that sounds like a whoop. Vomiting and exhaustion commonly follow coughing episodes, and young children can turn blue from lack of oxygen.
People appear normal between attacks, which are more intense and numerous at night. The fits last six to eight weeks before a final, convalescent phase, when the coughing becomes less severe and gradually disappears over several months. Complications include broken ribs, dehydration, hernias, pneumonia and seizures.
Whooping cough is most contagious in the first two weeks of the disease, often before a noticeable cough develops. As a result, Dr. Cortese said, "people usually don't go to the doctor until it's too late" to stop them from spreading the disease.
Positive diagnoses are also more difficult to obtain after a couple of weeks because of increasing problems in culturing the pertussis bacterium from samples of mucus - difficult anyway because the germ is picky about the circumstances under which it will grow. A test known as a polymerase chain reaction can detect the presence of pertussis DNA in mucus up to six weeks after infection. But medical experts said so far there were no standards for using the test for diagnosis, and it is not widely used.
Ms. Wilson had a blood test that revealed she had pertussis antibodies. But without her corroborating symptoms, it would have been hard to discern whether this meant she had lingering immunity or a recent infection.
Like diagnosis, effective treatment depends on timing. Doctors say the best chance for reducing the duration and severity of the illness is to take the antibiotic erythromycin within the first week of infection.
"After that, there's not much you can do" but let the disease run its course, said Beverly Connelly, an infectious disease specialist at Cincinnati Children's Hospital.
Cough suppressants have little or no effect, though some patients report that sleeping upright helps. "I slept in a recliner in the living room for months," Ms. Wilson said.
Medical experts have long been puzzled as to what causes the oppressive cough, which lingers long after the pertussis bacterium has disappeared from the patient's system.
"It's mysterious, but there's a suspicion that the toxins the bacteria produce could affect nerves in the lungs or perhaps the part of the brain that controls cough," said Dr. Cortese at the C.D.C.
Medical experts predict that the number of pertussis cases will continue to grow rapidly over the next few years until a large part of the population has been exposed and develops immunity. In the meantime, public health officials warn parents to protect their infants by strictly adhering to vaccination schedules. Delaying inoculations by even a month or two can make children more vulnerable. And experts say to keep babies away from people who have coughs.
"Don't think grandma just has a cold because maybe not," Dr. Cortese said.
Thanks, neverdem.
FYI, Lady Jag.
FReepmail me if you want on or off my health and science ping list.
Hm. Wonder how one would go about getting vaccinated, if one were over there... would their bureaucracy even allow it?
DPT booster -- ouch!
Hm. Wonder how one would go about getting vaccinated, if one were over there... would their bureaucracy even allow it?
Read later. Thanks.
I think Mara Liasson (don't know spelling)of the Fox News All-Stars had this. That woman had a horrible cough for at least six months last year.
Gee, I might have had this over christmas.
I had a cough that was killer, couldn't sleep,
thick mucus, started out like the flu, but I didn't
get sick, just the cough, and it would get so bad (fast, repetative,wheezing.) that I would get out of breath.
Had to sleep, or try to, sitting up on the sofa.
Took some of the joy out of the holiday, and took me
a month to stop coughing and wheezing.
Yikes.
Younger daughter (almost 20) couldn't take the pertussis vaccine. She had a severe reaction with her first shot. Wouldn't you think that older folks would react even more?
Another consequence is that there is no ongoing research on making safer Pertussis vaccines with genetic engineering and last I heard there is only one US manufacturer of pertussis vaccine.
The pertussis vaccine currently in use in the U.S. does not confer complete protection. However on the whole, vaccinated children who contract pertussis are generally less ill than those who are not vaccinated.
The fact that there is no sort of booster for adults available in the U.S. is troublesome. The immunity conferred by the pertussis vaccine wears off about 10-15 years after administration. By the age of 20, most people have lost the immunity they gained from the vaccine.
Now, that's really not a terrible problem for adults who contract pertussis. In adults, the disease is generally much milder and often goes undiagnosed. But the fact that it can go undiagnosed is what raises problems. Adults who have contracted the disease can easily infect children. And young children who have not completed the full course of vaccination can thus become quite ill.
While saying this brings us into a different discussion entirely, one reason for the increases in pertussis (both childhood and adult) cases is illegal immigration. Many illegal immigrants and their children have never been vaccinated.
I always thought she was Charles Krauthammer in drag.
Good luck. The FDA is doing its best to remove things from the market, not allow people access to things that they might want and benefit from. :-(
There were some cases of severe reaction to the old pertussis vaccine. However, the concerns about those few instances were blown far out of proportion in relation to the number of such severe adverse reactions that actually occurred. The previous vaccine was believed to confer better protection.
You must have missed all the anti-vaccination types on FR. It's certainly not just illegal immigrants.
Eek...something new to worry about?
Sounds a lot like your troubles, Corin, though I suppose if it WERE this, your family woulda had it.
Whenever we gave the "old" vaccine (aka whole cell pertussis vaccine), the standard advice to parents was that if the child had 3 or more hours of inconsolable fussiness, they needed to come back in to see the doctor. If this occurred, they could no longer receive pertussis vaccine. Since the introduction of the acellular pertussis vaccine, that's not an issue.
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