Straight Talk on the 100-Day Cough
by Lauren Feder, MD
Issue 164 January-February 2011
Please see the accompanying article by Dr. Jay Gordon for more information on whooping cough and the pertussis vaccine. You can also purchase this article along with "The Problem with Pertussis Vaccines,” by Barbara Loe Fisher in the Mothering Shop.
In June 2010, news reports confirmed that whooping cough was now an epidemic in California.1Physicians were inundated with calls from concerned parents. As the disease spread in California and across the nation, it became important that people inform themselves about what whooping cough is, and their options for vaccines and treatment.
Having had whooping cough does not provide lifelong immunity. Adolescents and adults who had the infection in childhood might get milder forms of whooping cough that can go undetected, or be diagnosed as bronchitis or a simple cough. The several stages of whooping cough can last a total of two to three months, earning it the nickname “the hundred-day cough.”
What is whooping cough?
Whooping cough, aka pertussis, is a contagious illness caused by the Bordetella pertussis bacterium. Once a common childhood illness in the US, it earned its popular name from the characteristic whooping sound of the cough associated with the disease. The pertussis bacterium is easily spread by contact with an infected child or adult in the first two to three weeks of infection, usually before the illness has been accurately diagnosed. The incubation period is commonly 7 to 10 days, with a range of 4 to 21 days.
Like many illnesses, pertussis begins with a cold-like stage in which the sufferer is most contagious, with the familiar symptoms of runny nose, sneezing, low-grade fever, and mild cough. Within one to two weeks the cough worsens, developing into attacks or spells or fits: a rapid series of coughs followed by a long inhalation with the characteristic crowing sound or high-pitched whoop. Choking, gagging, or vomiting while coughing can be triggered by the buildup of thick mucus in the lungs. In more severe cases, a child can turn blue in the face (aka cyanosis). Although a child may be exhausted immediately following a coughing spell, he or she often appears and acts normal between spells.
How common is whooping cough?
By the 1970s, the Centers for Disease Control and Prevention (CDC) reported, the incidence of whooping cough had decreased by 99 percent since the inception of the whole-cell DTP vaccine.2In the holistic medical community, it is generally felt that individual cases and symptoms of pertussis are less severe now than in the past, due to improvements in sanitation, nutrition, and education and because of more sophisticated medical treatments for complications. In the US, pertussis epidemics happen every three to five years; approximately 17,000 cases were reported in 2009.3According to the CDC, pertussis is “one of the most common vaccine-preventable childhood diseases” in ?the US.4From 1999 to 2004, 91 infant deaths ?in the US were attributed to pertussis.5
However, since the 1980s, the number of reported cases of pertussis has increased.6That whooping cough is becoming more common in adolescents and adults than it was in the past7, 8may be due to improved abilities to recognize, diagnose, and report cases of pertussis.9In general, pertussis cases are vastly underreported.10Increases in whooping cough among adolescents and adults since the 1980s are most likely attributable to their immunity waning in the years following their vaccination.11
Outbreaks of whooping cough are also caused by Bordetella parapertussis, which is closely related to Bordetella pertussis. The symptoms of B. parapertussis are usually milder than those ?of B. pertussis; because of this, both infections remain underestimated. In general, infection by B. pertussis and/or B. parapertussis in the immunized population is common, and B. parapertussis is more prevalent than was previously known.12
The original pertussis vaccine was the whole-cell diphtheria-tetanus-pertussis (DTP) vaccine. However, the severe complications of the whole-cell DTP vaccine led to the development of the acellular pertussis (aP) version of this vaccine (DTaP). In fact, the publicity surrounding the complications of the original pertussis vaccine is, to a large extent, responsible for the public’s current awareness of vaccine injuries in general.
The DTaP vaccine grants immunity for 5 to 10 years.13However, according to a study that compared the success rates of the two vaccines, the incidence of pertussis was lower in children who were given a combination of DTP and DTaP than in children who received only DTaP. This suggests that the rate of failure to immunize is higher in the DTaP vaccine.14According to the CDC, while the rate of pertussis immunization in the US has remained high,15whooping cough continues to reemerge. One theory for this is that the strains of the B. pertussis bacterium have evolved since introduction of the vaccines, much as other bacteria have evolved to become more resistant to commonly used antibiotics.16
Despite widespread programs of vaccination, epidemics of pertussis continue to occur every three to five years. While the reason or reasons for this remain unclear, what is known is that immunity from vaccines wanes over time, which can result in increased incidence among adolescents and adults.17In addition, many children and adults are carriers of pertussis while showing no symptoms of the disease.
Thus far, the worst case of pertussis I’ve seen was in an eight-month-old girl who was hospitalized for a few days despite having had two DTaP shots. Following the hospitalization, the patient and her family came to my office for homeopathic treatment to expedite her healing. Now she is fine.
Nowadays, the pertussis vaccine is given to children as part of the DTaP series. The five doses of this series are given at the ages of 2 months, 4 months, 6 months, 15 to 18 months, and 4 to 6 years. The pertussis vaccine is given only to children younger than seven years because it can cause severe reactions in older children.
The complications of the pertussis vaccines are well documented and include local swelling at the injection site, fever, high-pitched screaming, convulsions, mental retardation, and death. Although reactions to the acellular form of the vaccine are milder than to the whole-cell vaccine, severe reactions to the DTaP vaccine have occurred, including encephalitis and death.
Although the B. pertussis bacterium can cause ear infections, dehydration, convulsions, and, in rare instances, even brain damage or death, one of the complications most commonly associated with whooping cough is pneumonia. Pertussis poses the greatest risk to infants and small children; their air passages, which are much narrower than those of older children and adults, can be more quickly blocked by mucus.
On rare occasions, DTaP can cause serious complications. These include:
• fever higher than 105° F (1 child out of 16,000)18
• nonstop crying (1 child out of 1,000)19
• seizure (1 child out of 14,000)20
• serious allergic reaction (fewer than 1 in ?a million)21
The pertussis vaccine should not be given to children who have a history of convulsions, brain disorder, or abnormal development. Some of the families in my practice have refused the pertussis shot because of a family history of seizures.
Treatment for Whooping Cough
If you suspect that your child has whooping cough, see your pediatrician. A case of whooping cough usually lasts about six weeks. Because pertussis is contagious, avoid contact with others.
The standard treatment includes the general support of rest and liquids. Your doctor will probably prescribe erythromycin or azithromycin, as it is felt that such antibiotics render a child less contagious. While it is still in question whether an antibiotic changes the course of the illness, people with whooping cough are generally considered no longer contagious after the fifth day on antibiotics. Holistic medicine and homeopathy may shorten the course and severity of the illness.
But again: If you suspect that you or your child has whooping cough, see your healthcare provider.
NATURAL TREATMENTS for WHOOPING COUGH
From your pantry
Chamomile tea for chest congestion, bronchitis
Lemon tea for watery, thin discharges, tickly coughs, bronchitis
Onion breaks up thick mucus and congestion. Place sliced onion on a plate by the bed at night.
Aconitum napellus for sudden attacks of croupy coughs at the beginning stages of illness and cough
Antimonium tartaricum for rattling in the chest ?with a strong, loose cough when chest feels full of mucus
Bryonia alba for dry, racking, painful cough in chest and head, made worse by motion and better by being still
Coccus cacti for winter coughs with tickling in the throat, and strong fits of coughing that end in choking ?or vomiting
Cuprum metallicum (Cuprum) for spasmodic ?coughing fits
Drosera for violent coughing spells ending in choking, gagging, or vomiting. Sometimes these coughs are so strong that the child can hardly catch her breath. Drosera is indicated for barking coughs, whooping cough, croup, and coughs that are worse after midnight, commonly accompanied by a bloody nose and a hoarse voice.
Hepar sulphuris calcareum for croup that is worse in the morning and evening (until midnight); indicated following Aconitum napellus, especially with croup with rattling mucus in chest that is worse in the morning
Ipecacuanha for whooping cough and other severe suffocative coughs that end in retching, vomiting, or cyanosis, with stiffness in the body; the child feels nauseated and has an aversion to food (including the smell of food)
Pulsatilla for coughs with yellow-green mucus; cough is worse at night and interferes with sleep
Spongia tosta for dry coughs that sound like a saw going through wood; often used for croup. Useful for croupy coughs that are worse before midnight, accompanied by a dry, barking cough that can sound like a seal.
Lauren Feder, M.D. is a nationally recognized physician who specializes in primary care medicine, pediatrics and homeopathy. Known for her holistically minded approach and combining the ‘best of both worlds,’ Dr. Feder is a frequent lecturer for parents and professionals and has been seen nationally on various health-oriented television and radio programs including most recently on The Doctors, Oprah and Friends interviewed by Dr. Mehmet Oz. She is the president of the Holistic Pediatric Alliance, author of Natural Baby and Childcare and The Parents’ Concise Guide to Childhood Vaccinations, and is in private practice in Los Angeles.
1. California Department of Public Health, “Whooping Cough Epidemic May Be Worst in 50 Years,” press release 10-041 (23 June 2010): FACE="MyriadPro-Regular">www.cdph.ca.gov/Pages/NR10-041.aspx.
2. Centers for Disease Control and Prevention, “Pertussis Vaccination: Use of Acellular Pertussis Vaccines Among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices (ACIP),” FACE="MyriadPro-Regular">Morbidity and Mortality Weekly Report 46, no. RR-7 (28 March 1997): FACE="MyriadPro-Regular">www.cdc.gov/mmwr/PDF/rr/rr4607.pdf.
3. Centers for Disease Control and Prevention, “Pertussis (Whooping Cough): Outbreaks,” FACE="MyriadPro-Regular"> www.cdc.gov/pertussis/out?breaks.html.
4. Department of Health and Human Services, Centers for Disease Control and Prevention, “Parents’ Guide to Childhood Immunizations” (2007): 20; FACE="MyriadPro-Regular">www.cdc.gov/vaccines/pubs/parents-guide/default.htm.
5. Dana L. Haberling, MSPH, et al., “Infant and Maternal Risk Factors for Pertussis-Related Infant Mortality in the United States, 1999 to 2004,” FACE="MyriadPro-Regular">Pediatric Infectious Disease Journal 28, no. 3 (March 2009): 194–198.
6. Centers for Disease Control and Prevention, “Pertussis (Whooping Cough): Fast Facts” (August 2010): FACE="MyriadPro-Regular">www.cdc.gov/pertussis/fast-facts.html.
7. Hazel Guinto-Ocampo, MD, Bryon K. McNeil, MD, and Stephen C. Aronoff, MD, “Pertussis,” eMedicine (27 April 2010): http://emedicine.medscape.com/article/967268-overview.
8. National Foundation for Infectious Diseases, “Pertussis Disease Fact Sheet” (March 2005): FACE="MyriadPro-Regular">www.nfid.org/_old/factsheets/pertussis.pdf.
9. Centers for Disease Control and Prevention, “Pertussis—United States, 2001–2003,” FACE="MyriadPro-Regular">Morbidity and Mortality Weekly Report 54, no. 50 (23 December 2005): 1283–1286; FACE="MyriadPro-Regular"> www.cdc.gov/mmwr/preview/mmwrhtml/mm5450a3.htm.
10. National Foundation for Infectious Diseases, “Facts About Pertussis for Adults” (January 2008): FACE="MyriadPro-Regular">www.nfid.org/pdf/fact?sheets/pertussis.pdf.
11. Texas Medical Association, “Pertussis (Whooping Cough)” ?(8 September 2010): FACE="MyriadPro-Regular">www.texmed.org/Template.aspx?id=8228.
12. Qiushui He, MD, et al., “Whooping Cough Caused by ?Bordetella pertussis and Bordetella parapertussis in an Immunized Population,” FACE="MyriadPro-Regular">Journal of the American Medical Association 280, no. 7 (1998): 635–637; FACE="MyriadPro-Regular">www.jama.ama-assn.org/cgi/content/full/280/7/635.
13. San Mateo County Health System, “Public Health Advisory: Pertussis Is Peaking. Take Action!” Public Health Fax Advisory (28 June 2010): FACE="MyriadPro-Regular">www.co.sanmateo.ca.us/Attachments/health/pdfs/Public%20Health/cd_program/Pertussis/pertussis_june_2010.pdf.
14. D. Vickers et al., “Whole-Cell and Acellular Pertussis Vaccination Programs and Rates of Pertussis Among Infants and Young Children,” FACE="MyriadPro-Regular">Canadian Medical Association Journal 175, no. 10 (7 November 2006): 1213–1217; FACE="MyriadPro-Regular">www.cmaj.ca/cgi/reprint/175/10/1213.
15. Centers for Disease Control and Prevention, “Immunization Rates Remain Stable at High Levels Among the Nation’s 19- through 35-Month-Old Children,” press release (27 August 2009): FACE="MyriadPro-Regular">www.cdc.gov/media/pressrel/2009/r090827.htm.
16. F. R. Mooi, I. H. M. van Loo, and A. King, “Adaptation of Bordetella pertussis to Vaccination: A Cause for Its Reemergence?” FACE="MyriadPro-Regular">Emerging Infectious Diseases 7, no. 3, Supplement (June 2001): FACE="MyriadPro-Regular">www.cdc.gov/ncidod/eid/vol7no3_supp/mooi.htm.
17. E. Grilc and N. Pirnat, “Pertussis Outbreak in Recently Vaccinated Children in a Kindergarten in Ljubljana during a Resurgence in Pertussis Incidence,” FACE="MyriadPro-Regular">Eurosurveillance 10, no. 33 (18 August 2005): 2779; FACE="MyriadPro-Regular">www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2779.
18. Centers for Disease Control and Prevention, “DTaP Vaccine Information Statement: Diphtheria, Tetanus & Pertussis Vaccines: What You Need to Know” (17 May 2007): FACE="MyriadPro-Regular">www.cdc.gov/vaccines/pubs/vis/downloads/vis-dtap.pdf.