Gravestone for two children who died of whooping cough and measles.

A gravestone for two siblings* who died of whooping cough and the measles within two days of each other in 1821 in Massachusetts, according to Whooping cough is making a comeback. Fortunately, we have better hospitals and treatments, but people—especially babies—still die of it.

by James Hubbard, M.D., M.P.H.

Whooping cough (pertussis) has become epidemic in some areas of the United States. For instance, in 2011 in Washington State, there had been 180 cases from January 1 to June 14. In 2012, there have been 2,520. That’s the largest number of cases since 1942.

Whooping cough is very contagious, and the current vaccine’s not working so well. So it’s something you need to know how to treat if you can’t get to a doctor.

The New Vaccine That Runs Out of Juice

To cut back on potential side effects, a few years ago they changed from using a vaccine of dead pertussis bacteria to using antigens (proteins) derived from the bacteria. Exposure to these proteins is what causes your body to create antibodies against it.

Apparently, this new vaccine doesn’t contain enough variety of the proteins or something because the new shots work really well for up to two years. Then, your immunity starts weakening, and as time goes by, you become more and more susceptible to getting the disease.

Now, the new vaccine’s not completely a loss. If you get the shots, you have an eight times lower risk of getting the disease. And, if you do get whooping cough, you’ll probably have a less severe case. Still …

Whooping Cough: Miserable for Adults, Worse for Babies … and Very Contagious

Can you imagine being in a disaster setting in a group where someone gets this contagious disease? Whooping cough is especially deadly in children under a year old. Up to half need hospitalizations, and many get pneumonia. Some die.

Older children and adults fare better. They just cough so severely they tend to get hernias and break ribs. They lose a lot of weight because they cough so hard they vomit after eating. At least thirty percent have urinary incontinence.

Listen to a Whooping Cough

View photos of sick children with whooping cough on this CDC page. (Caution: graphic.)

Cough medicines don’t help at all. Oh, and pertussis is also called the hundred-day cough. Actually the really severe cough lasts about three to six weeks followed by six weeks of a lesser cough.

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Symptoms: Like a Cold … at First

Whooping-cough symptoms come in three stages.

Stage 1: For the first one to three weeks or so, the symptoms are no different than with a common cold—runny nose, mild coughing, maybe a low-grade fever.

Treatment for Whooping Cough: 4 Antibiotics

For whooping cough, the antibiotic of choice is erythromycin or one of its derivatives—azithromycin (Z-Pak) or clarithromycin (Biaxin). An alternative is the sulfa drug trimethoprim-sulfamethoxazole (Bactrim or Septra).

You can find specifics about these treatments and side effects in this article from the Centers for Disease Control and Prevention.

Here’s the basic dosing:

1. Azithromycin. It is administered as a single daily dose and is the safest one for children under one month of age.

  • Infants under six months: 10 mg/kg per day for five days.
  • Infants and children older than six months: 10 mg/kg (maximum: 500 mg) on day one, followed by 5 mg/kg per day (maximum: 250 mg) on days two through five.
  • Adults: 500 mg on day one, followed by 250 mg per day on days two through five.

2. Erythromycin.

  • Infants older than one month and older children: 40 to 50 mg/kg per day (maximum: 2 g per day) in four divided doses for fourteen days.
  • Adults: 2 g per day in four divided doses for fourteen days.

3. Clarithromycin.

  • Infants and children older than one month: 15 mg/kg per day (maximum: 1 g per day) in two divided doses each day for seven days.
  • Adults: 1 g per day in two divided doses for seven days.

4. Trimethoprim-sulfamethoxazole (Septra or Bactrim).

  • Infants older than two months and children: trimethoprim 8 mg/kg per day, sulfamethoxazole 40 mg/kg per day in two divided doses for fourteen days.
  • Adults: trimethoprim 320 mg per day, sulfamethoxazole 1,600 mg per day in two divided doses for fourteen days.
  • Not for babies under two months old.

Stage 2: After that, for the next one to ten weeks, you start the whooping episodes of rapid, violent coughing, followed by trying to catch your breath (that’s when you whoop), followed by more coughing. Often people turn blue in the face during these episodes.

Stage 3: For most people, next comes one to three weeks of less coughing and gradual recovery.

Contagious Before You Know You’re Sick

You already have the disease and are contagious for five to twenty-one days before your symptoms begin. You stay contagious for up to about three weeks after the whoop starts, though if you start antibiotics, you’re only contagious for about another week.

3 Whooping-Cough Treatments for 3 Problems

Ideally, you should seek medical help at the onset of stage 2 or even before symptoms begin if you’ve been in close contact with someone who has had the disease. But in case you can’t get to a doctor, here are the treatments for whooping cough:

  • Humidity. It helps break up the thick mucus. Use a humidifier, or get some steam going in the bath or shower. You could heat up a pan of water and close up the room or cover yourself and the pan under a sheet. Just be very, very careful of anything hot around children.
  • Small meals. You’re less likely to vomit them up.
  • Antibiotics. Since pertussis is a bacteria, antibiotics help. You can start them in the first few days of stage two (with the whooping). You can also take them for the same amount of time for prevention if you’ve been exposed.

Back to Immunizations

Although the vaccine is far from perfect, it does decrease your risk of disease and may decrease the severity if you get it.

The pertussis vaccine is given in a shot that also contains diphtheria and tetanus. It’s first given at two, four, and six months old. You should get a fourth at around twelve years old and a fifth at around eighteen.

Adults don’t routinely get boosters after that, so we’re at risk for getting whooping cough. But there are tetanus boosters for adults that also have pertussis (whooping cough) in them. You need a tetanus shot at least every ten years anyway. So call around to find a place that has the combination vaccine. If you get whooping cough you’re going to be out of commission for weeks, and you could jeopardize a baby’s life by the exposure.

What do you think? Ever had the stuff?

*The boy who died of whooping cough and the measles, Caleb Francis Miller, was a baby, according to No age is given for his sister, Mary Ann Bucklin Miller.

Photo of gravestone at Burial Place Hill in Rehoboth, MA, by Mr. Ducke on Flickr.