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What is Pertussis (Whooping Cough)?
Pertussis, commonly referred to as whooping cough, is a highly contagious respiratory disease caused by the Bordetella (B.) pertussis bacterium. B. pertussis bacteria attach themselves to the mucus membranes of the respiratory tract and cause inflammation in the body. The major symptom of B. pertussis whooping cough disease is uncontrollable coughing.
In advanced stages, thick mucous develops in the lungs and clogs air passages, triggering violent episodes of coughing, choking and vomiting up of mucus followed by a high-pitched intake of breath that sounds like "whoop." With whooping cough disease, it is possible to have such violent coughing spells, especially at night, that large amounts of mucous are vomited up through the mouth and nose and interfere with breathing.
The B. pertussis bacteria release several toxins, including pertussis toxin (PT) and endotoxin. In severe cases of whooping cough disease, complications include high fever, brain inflammation, convulsions, pneumonia, pneumothorax, hernias, subdural hematomas and death.
Symptoms of B. pertussis at its onset are similar to the common cold, or an allergy attack with stuffy or runny nose, dry cough, loss of appetite, fatigue and, sometimes, a low fever. After one to two weeks, the disease usually progresses to bursts of spasmodic coughing (paroxysms) with large amounts of mucous, gagging and vomiting with or without a whoop that becomes worse at night. During the day, the child or adult may look and feel fine with the exception of frequent coughing spasms. A final recovery stage with only occasional coughing fits may last for weeks or even months. Click here to hear what whooping cough can sound like.
Sometimes infants or older children and adults don’t cough with a whoop. Small babies and very young children, who are gasping for air, may have a red face, bulging eyes, blue lips and may stop breathing for a few seconds or longer because the thick mucus clogs their small airways. Sometimes babies must have the mucous suctioned from their throats so they can breathe.
Adults and adolescents with whooping cough may have milder symptoms, such as a persistent, mucous-producing cough that goes on for 4-8 weeks. Often older children and adults do not make the whooping cough when they cough.
Symptoms of pertussis are sometimes milder in those who have had one or more doses of pertussis containing vaccines (DPT, DTaP, Tdap) and doctors or nurses may not suspect B. pertussis whooping cough in vaccinated children, adolescents and adults, who present with a bad cough. Many cases of pertussis go undetected because they are mistakenly diagnosed by medical personnel as an allergy attack, bronchitis, influenza or other upper respiratory infection.
The only sure way to find out if you or your child have B. pertussis or Bordetella parapertussis (or another respiratory disease caused by other viruses or bacteria), is to have a lab test that will positively confirm the exact organism causing the whooping cough symptoms. Bordetella parapertussis, another pertussis disease, can look identical to B, pertussis whooping cough, however symptoms are generally milder. B. parapertussis is increasing in the U.S. and other countries, which have had high pertussis vaccination rates for few decades. There are estimates that perhaps 30 percent or more of whooping cough disease in highly vaccinated populations is caused by B. parapertussis organisms. It is possible to have both B. pertussis and B. parapertussis infections at the same time. Parapertussis is often milder than B. pertussis but can also involve serious complications, which lead to pneumonia and death. Pertussis vaccines widely used around the world do not protect against B. parapertussis. There is no vaccine for B. parapertussis.
It is important to be equally concerned and knowledgeable about the risks of pertussis disease as we are about the risks of pertussis vaccine. Both B. pertussis whooping cough and the pertussis vaccine carry risks. Pertussis disease has the potential to cause seizures, brain damage, and even death, just as the vaccine can. Most of America’s medical community believes that the risk of serious injury or death from pertussis is greater than the risk of injury or death, which can be caused by pertussis vaccine. However, recognition of and concern about the risks of pertussis disease does not diminish our need and responsibility to acknowledge the need to minimize pertussis vaccine risks.
The challenge today is for parents, physicians, scientists, manufacturers and health officials to recognize the risks of both the disease and the vaccine and work to protect the health and well being of every child.
IMPORTANT NOTE: NVIC encourages you to become fully informed about Pertussis and the Pertussis vaccine by reading all sections in the Table of Contents , which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.
14 He Q, Viljanen MK, et al Whooping cough caused by Bordetella pertussis and Bordetella parapertussis in an immunized population. JAMA.1998 Aug 19;280(7):635-7.
15 CDC Surveillance Manual Chapter 10: Pertussis – Disease Description. 6th Edition. 2013
16 Liese JG, Renner C, Stojanov S, et al Clinical and epidemiological picture of B pertussis and B parapertussis infections after introduction of acellular pertussis vaccines Arch Dis Child 2003;88:684-687.