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$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.