Taking aim at whooping cough: Health officials work to slow epidemic, protect babies | by Debra Melani

Posted on Fri, Jun 14, 2013

It was well past midnight, and Valerie Castillo was so worried about her 3-week-old son’s cough, she wouldn’t put him down. She finally propped little Jeremiah on her chest and fell into a few minutes of fitful sleep. When she awoke at 2 a.m. and looked down at her baby, he was blue.

“I freaked out,” says Castillo, who had taken Jeremiah to the doctor two days before, but was sent home with a “cold”

diagnosis. She rushed him to the bathroom, where she tried everything from splashing cold water on his face to mouth-to-mouth breathing, but nothing worked. “I screamed for my daughter to get my phone so I could call 9-1-1, and after that he gasped and took a breath.”

Castillo, 24, raced to the hospital, her baby’s breath stopping once on the way. When the Denver mom frantically handed her son over to the medical staff at North Suburban Medical Center, she had no idea that she wouldn’t hold Jeremiah again for a long and stressful two weeks.

Although Jeremiah’s is one of the more severe cases, his story hits home for a growing number of people whose lives are being affected by whooping cough, a highly-contagious bacterial infection, also known as pertussis, that has recently hit Colorado and other parts of the country hard. The year-round disease can be life-threatening, particularly in infants, and recently prompted a recommendation that all women receive a vaccine in their third trimester during every pregnancy.

Jump in numbers

“We are certainly seeing a lot more of it,” says Dr. Mary Saunders, a pediatric emergency medicine specialist who covers

HealthONE’s Swedish and Presbyterian/St. Luke’s medical centers. “I have parents come in worried because they keep getting notes home from school that a student has it. It’s definitely more prominent than it ever has been in my career.”

Last year, when Jeremiah was hospitalized, Colorado’s reported pertussis cases jumped from 419 in 2011 to 1,516, the highest number of cases the state has seen in 60 years. “It’s a problem,” says Dr. Wendi Drummond, pediatric infectious disease specialist with Rocky Mountain Hospital for Children. “And the only real way to intervene is through vaccinations.”

Relatively recent recognition that the vaccine wanes, along with the fact that it is not 100-percent effective in preventing the disease, can explain part of the prevalence of pertussis, which also tends to peak in cycles. “And, just as with any vaccine-preventable epidemic, people aren’t getting vaccinated,” Saunders says.

When Drummond’s own daughter contracted whooping cough at age 1, she was nearly through her vaccination course (see sidebox), and so suffered a milder case. “She was still really sick from it,” Drummond says.

The classic case starts out like a cold. But within two weeks, the cough can become more severe, coming in fits. Vomiting, breathlessness, change in facial color, and a whooping sound may follow the violent fits, which can sometimes result in broken ribs. In between, a person might feel fine, but the cough, often most severe at night, can last for months, earning it the nickname of the 100-day cough. Quick diagnosis and treatment with antibiotics can help ease the severity and slow the disease’s spread.

The infant dilemma

In infants, pertussis can be harder to diagnose, because they often don’t have the signature whoop with a cough, Saunders says. “The ‘Catch 22’ is that they’re the ones that get the sickest,” she says, adding that any parent who thinks an infant is having trouble breathing should dial 9-1-1.

Apnea (halted breathing) is more common in infants with whooping cough, and half of those under age 1 affected with the disease are hospitalized. Little Jeremiah was promptly transported from NSMC to P/SL, where he spent 14 days in intensive care. “He stopped breathing twice in the ambulance,” says Castillo, who had suspected Jeremiah had something worse than a cold but didn’t question the doctor.

The hardest part was seeing her new baby hooked up to all of the tubes, Castillo says. “He was asleep the entire time. He had a breathing tube; he had oxygen; he had a PICC line in his groin for the medicine,” she says, referring to an intravenous line used to supply the antibiotics needed. “And I couldn’t hold him for 14 days,” says Castillo, who slept on the hospital couch that whole time, her husband and parents caring for her daughter.

Protecting the babies

Health officials never pinpointed how Jeremiah contracted the disease, but Drummond’s daughter’s infection was traced back to “the one family member who hadn’t been vaccinated,” illustrating the need for what doctors call “cocooning,” she says. Because infants can’t complete a protective vaccination course before age 1, the Centers for Disease Control and Prevention recommend vaccinating all of those around them. Any adult who did not receive a booster as a teen and comes into contact with a baby should be vaccinated.

In response to a rising number of cases and infant deaths, the CDC now recommends vaccinations for all pregnant women, regardless of vaccination history, in their third trimester, which can pass antibodies onto the fetus and help protect baby in those first, most susceptible, months. Up to 40 percent of infant cases are traced back to the mother, according to the CDC.

Castillo offered two pieces of advice: One, “Get your family vaccinated. Afterward, the doctors told me that when Jeremiah was in the ICU, they didn’t think he was going to make it. I almost lost him.” And two, “Always trust your motherly instincts. I wish I did.”

DTaP (diphtheria, tetanus, pertussis) immunization schedule:

• 2 months
• 4 months
• 6 months
• Between 15 and 18 months
• Between 4 and 6 years
• Booster: After age 11

For a full vaccination schedule, go to: www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html

U.S. pertussis cases and deaths in children dropped considerably after routine vaccination was begun.

• Average annual numbers pre-vaccine
• Cases: 200,000
• Deaths: 9,000
• Average annual numbers post-vaccine
• Cases: 10,000-25,000
• Deaths: 10-20

Source: Centers for Disease Control and Prevention

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Tags: Colorado, Denver, Dr. Mary Saunders, Dr. Wendi Drummond, DTaP, emergency medicine, immunizations, pediatric infectious disease specialist, Pediatrics 5280, pertussis, Presbyterian/St. Luke’s, Rocky Mountain Hospital for Children, symptoms, Whooping cough