$Unique_ID{BRK04099} $Pretitle{} $Title{Pertussis} $Subject{Pertussis Whooping Cough Catarrhal Stage Paroxysmal Stage Convalescent Stage} $Volume{} $Log{} Copyright (C) 1986, 1988 National Organization for Rare Disorders, Inc. 191: Pertussis ** IMPORTANT ** It is possible the main title of the article (Pertussis) is not the name you expected. Please check the SYNONYMS listing to find the alternate names and disorder subdivisions covered by this article. Synonyms Whooping Cough DISORDER SUBDIVISIONS Catarrhal Stage Paroxysmal Stage Convalescent Stage General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section of this report. Pertussis is caused by the coccobacillus Bordetella pertussis bacteria. This bacillus invades the mucous membranes of the nose, throat, trachea, bronchi, and bronchioles causing increased secretion of mucus which is initially thin and later thick. The disease lasts about six weeks and is divided into three stages: catarrhal, paroxysmal, and convalescent. Pertussis is extremely rare in populations where vaccination is used to prevent this disease in children. In fact, the best therapy for whooping cough is prevention through vaccination with the DPT vaccine. The U.S. Centers for Disease Control in Atlanta, GA suggests the small risk associated with the DPT vaccine is negligible compared to the severity of the disease itself. Symptoms The catarrhal stage of Pertussis begins gradually with symptoms such as sneezing, tearing, or other signs of a common cold, loss of appetite and listlessness. A troublesome, hacking, nocturnal cough which eventually remains throughout the day is also present. Fever is rare. The cough in Pertussis becomes paroxysmal (suddenly recurring) after 10 to 14 days. There may be from 5 to over 15 rapidly consecutive coughs followed by the whoop (a hurried, deep inhalation). Following a few normal breaths, another paroxysm may begin. Copious amounts of thick mucus may be expelled (usually swallowed by infants and young children) during or following the paroxysms. Vomiting after the paroxysms, which may be due to gagging on the mucus, is characteristic. Choking spells may be more common than whoops in infants. The convalescent stage of Pertussis usually begins within four weeks after onset. Paroxysms are not so frequent or severe, vomiting decreases, and the patient looks and feels better. Paroxysmal coughing may recur for months, usually as a result of irritation from an upper respiratory infection. In severe cases, Pertussis may cause brain damage or death. Causes Pertussis is caused by the coccobacillus Bordetella pertussis bacteria. Affected Population Pertussis especially strikes young children; in older children, the symptoms tend to be less severe. Adults and older people are rarely affected. Between 1984-1986, there were 5,685 cases of Pertussis reported to the Centers for Disease Control (CDC) in Atlanta, GA. The actual number of cases may be much higher. The World Health Organization (WHO) estimates that 60 million cases of Pertussis occur worldwide each year and that this disorder is responsible for 500,000 to one million deaths per year in the world. Related Disorders Bronchitis and influenza often show symptoms similar to Pertussis in the catarrhal stage (mucous discharge from the nose and throat). A positive culture for B Pertussis from a nasopharyngeal specimen indicates the presence of Pertussis. Therapies: Standard Hospitalization is recommended for infants with Pertussis. Small, frequent meals are advisable. Parenteral fluid (IV) therapy may be required to replace salt and water loss if vomiting is severe. In infants, careful suction from the throat may be necessary, and tracheostomy or nasotracheal intubation is occasionally necessary. Oxygen should be given if cyanosis (bluish coloration of the skin and mucous membranes) persists after removal of mucus. Seriously ill infants should be housed in a darkened, quiet room and disturbed as little as possible to prevent frequent coughing. Close attention should be paid to the nutritional needs of the infant, since malnutrition can contribute significantly to an adverse outcome of the disease. Expectorant cough mixtures, cough suppressants, and sedatives are of little value and should be used cautiously or not at all. Antibiotics should be used only for bacterial complications. The best therapy for whooping cough is prevention through vaccination with the DPT vaccine. The U.S. Centers for Disease Control in Atlanta, GA suggests the small risk associated with the DPT vaccine is negligible compared to the severity of the disease itself. The most severe complication of DPT vaccination is the very rare occurrence of irreversible brain damage caused by the Pertussis vaccine in DPT (Diphtheria, Pertussis, Tetanus vaccine). The American Academy of Pediatrics has reported "near epidemic" local outbreaks of whooping cough in at least 10 geographic areas in the United States where parents have not permitted immunization of their children against Pertussis because of this complication. The Centers for Disease Control tabulated over 2,000 cases of whooping cough in the United States during the first 11 months of 1985. Before the DPT vaccine became commercially available, 250,000 cases of whooping cough occurred yearly in the United States resulting in 4,000 to 5,000 deaths annually. A recent British study indicated that serious side effects due to the DPT vaccine occurred in only 1 out of every 110,000 DPT vaccinations, whereas the risk of suffering brain damage from whooping cough itself is 1 in every 9,500 cases. Research on a new, safer Pertussis vaccine is presently underway. Doctors fear an outbreak of whooping cough in the United States due to a recent rise in the cost of the DPT vaccine. Lederle Laboratories recently announced that the price of the vaccine will rise from $67 per vial to more than $170 per vial due to a substantial increase in product liability insurance. Lederle has been sued for $2.2 billion during recent years because of the vaccine. While the Centers for Disease Control estimates that only one in 100,000 to 300,000 children will develop serious complications from the DPT vaccine, it is estimated that one youngster in 9,500 who get whooping cough will suffer similar brain damage or will die as a consequence of the disorder. The State of Oklahoma presently leads the nation in cases of whooping cough. Therapies: Investigational Tests of experimental acellular bacterial Pertussis vaccines in Sweden and Japan have not shown a high success rate as initially hoped. According to the scientists, more study is necessary because of the complexity of the bacterial acellular vaccines. This disease entry is based upon medical information available through September 1989. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Pertussis, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 NIH/National Institute of Allergy and Infectious Diseases 9000 Rockville Pike Bethesda, MD 20892 (301) 496-5717 Centers for Disease Control (CDC) 1600 Clifton Road Atlanta, GA 30333 (404) 639-3534 Dissatisfied Parents Together (DPT) 128 Branch Road Vienna, VA 22180 DPT is a group of parents whose children have had serious adverse reactions to childhood vaccines. References CECIL TEXTBOOK OF MEDICINE, 18th ed.: James B. Wyngaarden, and Lloyd H. Smith, Jr., Eds.: W. B. Saunders Co., 1988. Pp. 1624-6. THE MERCK MANUAL 15th ed: R. Berkow, et al: eds; Merck, Sharp & Dohme Research Laboratories, 1987. P. 2008.