Whooping cough, also known as pertussis, is a bacterial respiratory tract infection. It begins looking like most other upper respiratory illnesses:

There may be nothing more than a runny nose and sneezing, often with little or no fever. The first coughs can look like a common cold. After 1-2 weeks, this may progress to a stage characterized by bursts of numerous rapid coughs (paroxysms, a “machine gun” cough) followed by a loud “whooping” inhalation, which gives Bordetella Pertussis the alternative name of “whooping cough.” That “whoop,” however is not an invariable part of the illness. A final recovery stage with coughing may last weeks or months. It’s a nasty illness which the Chinese call the “100 day cough” and their number is not far off. In most cases, whooping cough is a truly miserable cough that can ruin a family’s summer plans and mean a lot of missed days of work and school. In very rare cases, it can lead to much more serious conditions. The risk is highest for infants in the first six weeks of life who can get very sick and even die from it.

At the present time, I’m aware of two families in my practice who I believe have pertussis. I have no laboratory confirmation and in neither case has anyone in the family required hospital care.

The media and many official medical organizations get the discussion of “epidemics” wrong as often as they get it right and when they finally have something to talk about in the press it’s hard to sort out the truth. Before you read any further, have a look at this New York Times article about the whooping cough “epidemic that wasn’t.”

This time, unlike the H1N1 “pandemic” scare, the avian flu hype, the measles epidemic of 132 cases, the Jewish mumps scare and the West Nile Virus fear posters at every trail head, the pertussis outbreak information might be real and might be a reason to consider getting your child vaccinated. Whooping cough is not easy to diagnose with lab tests and doctors and parents often must rely on their clinical impression the cough and the pattern of disease spread. According to the official website of Children’s Hospital of Philadelphia, an article reviewed by Dr, Paul Offit estimates that there are between “600,000 to 900,000″ cases of pertussis each year in adults and adolescents alone. This stands at odds with official data from the CDC which puts that number at 5000-10,000. This type of disparity makes the discussion of pertussis outbreaks and vaccination just a little more difficult.

I think the DTaP vaccine is the shot with the best risk/benefit ratio and it’s the vaccine I use the most often in my office week. The official schedule includes far too many shots for six-week-old babies. A lot of harm and confusion could be alleviated by vaccinating later and not giving five or six vaccines at the same time.

This “acellular” vaccine does not contain mercury (almost no vaccines still do) and has been in use for nearly fifteen years in the United States and for quite a few years before that in other countries.

DTaP vaccine prevents whooping cough and may even prevent illness or lessen the severity of illness after the first vaccine. The routine schedule includes three doses in the first six months of life, a fourth at eighteen months of age, a fifth at age five years and booster doses of a new adolescent/adult vaccine. I don’t think your babies under a year of age should be given any vaccines, including this one. The CDC and most doctors, including my colleagues in this office, disagree.

Erythromycin, Zithromax and similar antibiotics can shorten the contagious phase of pertussis and can stop the spread of the illness in a family or a school. Our office has DTaP vaccine for infants and young children and another for older children, adolescents and adults. I do not recommend this vaccine for infants unless there are unusual risk factors in a baby’s life. Again, the vast majority of experts disagree, and I understand the need for public health considerations and preservation of herd immunity but still would rather vaccinate only after 12-24 months of age and feel comfortable, in most cases, giving no vaccine at all.

Ultimately this is a parents’ decision. Do not expect the media to let up on this issue in the near future.

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Tylenol Recall Update

Since the April recall, Children’s Tylenol, Benadryl, Motrin and other McNeil Pharmaceutical products are still unavailable for purchase. The latest report says we should not expect a return of these products until 2011. You can receive updates from the makers of Tylenol on their website. In the meantime, I recommend generic brands of diphenhydramine (Benadryl) for allergies and generic acetaminophen and ibuprofen for fever control when you need it.

Here is a resource to help you determine the proper amount of acetaminophen to give your child.

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Jay Gordon, MD, FAAP