Whooping Cough Makes a National Comeback, Hitting Adolescents Extremely Hard in the U.S., and Putting Infants at Risk

BLUE SPRINGS, Mo. -- With cold and flu season just around the corner, parents need to be aware of another serious illness that could affect their teenagers, pertussis.  Commonly known as whooping cough, pertussis is a highly contagious bacterial infection of the respiratory system that causes spasms of severe coughing and often masquerades as common ailments such as a cold or the flu. 

According to the Centers for Disease Control and Prevention (CDC), it is estimated that 39 percent of the reported pertussis

cases in 2003 affected children between the ages 10 and 19. Recent outbreaks

have prompted a growing concern in the public health community that parents

and teens are not aware of these trends and may assume this highly contagious

disease, which can be serious in infants, is just a cough.

According to the results of a new national survey of parents of teenagers

conducted by the Society for Adolescent Medicine (SAM), less than one in five

parents surveyed (approximately 18 percent) reported being concerned with the

prospect of their child contracting pertussis, and more than 25 percent aware

of the illness could not name one symptom. It is important for parents, teens

and healthcare providers to remember that childhood immunization against

pertussis wears off five to 10 years after the last routine vaccination shot

(administered when children are between four and six years old).  According to

the survey, the majority (85 percent) of parents of adolescents did not know

the duration of pertussis protection. Today, many adolescents are vulnerable

and unprotected against this serious disease.

There have been numerous outbreaks over the last year in many states,

including New York, Illinois and Wisconsin where most of the patients were

adolescents.  Afflicted teens are often forced to sit on the sidelines, unable

to attend classes, or participate in sports and social events for a week or

more because of the severity of their illness. In fact, pertussis sufferers

may experience more than two months of severe, uncontrollable coughing

episodes that can occur 15 times within 24 hours. These coughing fits can lead

to vomiting, a hernia, or even a broken rib. In some cases, pertussis can lead

to pneumonia.

Even when school is out of session, pertussis finds ways to sicken

teenagers, with recent outbreaks at summer sleep-away camps.  Although

whooping cough is rarely fatal in older children, the mortality rate is

highest in unvaccinated infants who can catch the illness from adolescent

family members or babysitters.

These survey results and the recent surge in pertussis outbreaks prompted

SAM to launch an educational campaign for teens and their parents, called

"More Than Just a Cough."  The campaign also encourages parents of teens to

schedule routine health visits.

 "After the immunization series is completed by age six, pertussis

immunization is rarely discussed at healthcare visits.  Few parents realize

that the protection from the pertussis immunization wears off after five to 10

years, leaving teens vulnerable to whooping cough," said Dr. Amy Middleman,

assistant professor of pediatrics, Adolescent Medicine Section, Baylor College

of Medicine. "Parents need to be made aware of pertussis symptoms.  Because

adolescents often do not exhibit the classic 'whoop' that is associated with

the disease, symptoms such as a mild fever, severe coughing fits and runny

nose are often mistaken for flu or the common cold.  However, anyone

experiencing these severe coughing fits for seven or more days should seek

diagnosis by a healthcare provider."

The CDC recommends that physicians test for pertussis if patients exhibit

symptoms compatible with the disease or develop an acute cough after exposure

to someone who has been diagnosed.  If caught early enough, antibiotics may

help alleviate symptoms or limit the spread of the disease.

To help educate parents and teens about whooping cough, SAM is providing

free information about the signs and symptoms of whooping cough, as well as

the importance of routine adolescent health visits, available at

http://www.adolescenthealth.org/whoopingcough.html.

Zachary's Battle With Pertussis: One Teen's Story

Over the past year, there have been pertussis outbreaks across the country

that have significantly impacted the adolescent community.  For example, 16-

year-old Zachary Graham, a competitive skier from New Hampshire, suffered a

bout of pertussis last winter.  When Graham began coughing just before the

Thanksgiving holiday, his parents assumed it was a result of a winter cold.

As a competitive athlete and school leader, Graham tried to dismiss his

illness and traveled to Lake Placid for Olympic skiing training sessions.

Within a few days, however, his condition worsened with severe coughing fits,

vomiting and difficulty sleeping and breathing.  As a result of his illness,

Graham missed most of his ski season and could not adequately prepare for

midterm examinations.  In fact, Graham experienced lingering symptoms of

whooping cough through early April of this year, five months after the initial

diagnosis.

"It took weeks to diagnose my son's condition since his symptoms mirrored

those of a common cold," said Graham's mother, Betty May Graham.  "In fact,

it wasn't until a visit with a pulmonary specialist that he was finally

diagnosed with whooping cough.  I was shocked when Zachary was diagnosed with

whooping cough because he had been vaccinated against the disease as an

infant.  It was such an emotional time for us and Zachary and if people lived

that experience with us, they would understand that whooping cough is a

terrible illness," she added.

About Pertussis

Pertussis can be difficult to detect because the first symptoms are

similar to the "common cold" with a mild fever, runny nose and a cough.

Symptoms generally progress to more severe coughing episodes, often with a

high-pitched "whoop," followed by vomiting.  These severe coughing spells can

last for more than two months.  A person experiencing these severe coughing

spells may become blue in the face, and infants may actually stop breathing

for a few seconds.  Between coughing spells, it is typical for individuals to

appear symptom-free.

It is important for parents to know that adolescents generally exhibit

different symptoms of the disease, often without the classic "whoop," making

it difficult to recognize.  While pertussis is threatening to all, this highly

contagious disease can be serious in infants who are too young to be fully

immunized.

Currently, pertussis vaccination is given in combination with diphtheria

and tetanus (DTaP) in five doses given at two, four and six months of age, 15

to 18 months of age and four to six years of age.  However, immunity to

pertussis wears off five to 10 years after the last childhood dose leaving

many teens unprotected against the disease.

"Adding a pertussis component to the current tetanus-diphtheria booster

vaccine routinely administered to 11 and 12 year olds could help control

community outbreaks and protect older children and teens from this serious and

highly contagious disease.  Such a vaccine is currently being reviewed by the

FDA, and may be available in 2005," Middleman said.

The Society for Adolescent Medicine founded in 1968, is the only

multidisciplinary professional healthcare organization in the United States

exclusively committed to improving the physical and psychological health and

well being of adolescents.  Its principal activities include the development,

synthesis and dissemination of scientific and scholarly knowledge unique to

the health needs of adolescents; professional development of students,

trainees, and practicing clinicians around adolescent health; as well as

advocating on behalf of adolescents.

Advocacy efforts are supported through local, state and national public

and private efforts to develop comprehensive, acute, chronic and preventative

health services for youth.  The Society publishes and disseminates scholarly

information related to adolescent health through its peer-reviewed monthly

Journal of Adolescent Health.  For more information, log on to

http://www.adolescenthealth.org.

Data was collected online between June 11, 2004 - June 17, 2004, with a

nationally representative sample of 1,622 parents (both mothers and fathers)

of adolescents. The survey was funded by GlaxoSmithKline.

Source: Society for Adolescent Medicine