Can Pertussis Cause Injury and/or Death?
Yes, according to the CDC, during 2017, out of the 15,808 reported cases of pertussis there were 13 deaths, with 4 deaths occurring in children less than one year of age. 1
However, there is a gap in medical knowledge in terms of predicting who will have a mild case of B. pertussis whooping cough and who will have a serious or even fatal case of this disease.
Pertussis can be quite serious, especially for young infants, whose tiny air passages can become clogged with thick mucous. Babies and very young children are at highest risk for apnea, pneumonia, seizures, encephalopathy, and death.2 The most serious complication of both whooping cough disease (and pertussis vaccine) is brain inflammation leading to varying degrees of permanent brain dysfunction.3
Pertussis toxin (PT) is one of the most lethal toxins in nature. The toxin induces lymphocytosis, leukocytosis, stimulates insulin secretion and sensitizes histamine, which is involved in the immune system’s inflammatory response.4
Pertussis toxin is thought to be the main component of B pertussis bacteria responsible for stimulating the production of protective antibodies during natural whooping cough infection and after pertussis vaccination.
Pertussis toxin is also thought to be the main toxin responsible for causing brain inflammation during B. pertussis whooping cough or after injection of pertussis-containing vaccines. (B. parapertussis bacteria do not secrete pertussis toxin and that is one reason why parapertussis is usually associated with milder symptoms). Because pertussis toxin can cross the blood brain barrier when conditions are right, brain inflammation (encephalitis) with convulsions that causes permanent brain damage has always been the most dreaded complication of both whooping cough and pertussis vaccination.5
Another toxin produced by B. pertussis bacteria during natural infection is endotoxin, which is also present in pertussis vaccines in varying amounts. 6 When the immune system detects the presence of endotoxins, it produces a defensive inflammatory immune response, including the release of large amounts of histamine that can lead to high fever, swelling, diarrhea, collapse, shock and death.7
The fatality rate for B. pertussis whooping cough disease is highest in infants under six months of age.8 Older children and adults can suffer rib fractures from violent coughing fits.9 Permanent health problems resulting from whooping cough disease (and the pertussis vaccine can include continuing seizure disorders,10 mental retardation, learning disabilities, ADD/ADHD and other chronic illness.11
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.
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1 CDC 2017 Provisional Pertussis Surveillance Report. Jan 5, 2018 66(52)
2 CDC Whooping Cough and the Vaccine (Shot) to Prevent It. Jan 31, 2018
3 CDC DTaP (Diphtheria, Tetanus, Pertussis) VIS. Aug. 24, 2018
4 Carbonetti NH. Contribution of pertussis toxin to the pathogenesis of pertussis disease. Pathog Dis. 2015 Nov; 73(8): ftv073.
5 Steinman L, Weiss A, et al Pertussis toxin is required for pertussis vaccine encephalopathy. Proc Natl Acad Sci U S A. 1985 Dec; 82(24): 8733–8736.
6 Geier DA, Geier MR. Clinical implications of endotoxin concentrations in vaccines. Ann Pharmacother. 2002 May;36(5):776-80.
7 Bannatyne RM, Cheung R. Reducing the endotoxic activity of pertussis vaccine. J Hyg (Lond). 1981 Dec; 87(3): 377–381.
8 CDC Whooping Cough and the Vaccine (Shot) to Prevent It. Jan 31, 2018
9 CDC Complications. Aug. 7, 2017
10 Preidt R. Kids' Whooping Cough and Risk of Epilepsy. WebMD. Nov. 3, 2015
11 CDC Whooping Cough and the Vaccine (Shot) to Prevent It. Jan. 31, 2018