The Whooping Cough: A Rising Epidemic
Zion Apple
July 16th, 2015
Course #498
Capstone
The Whooping Cough: A Rising Epidemic
Zion Apple
July 16th, 2015
Course #498
Capstone

Abstract
This research paper informs you about the disease pertussis or whooping cough as others may call it. This disease has been around for a very long time and even though there has been a vaccine for over 50 years, this disease seems to still be a problem. Experts are always working around the clock to find new and improved vaccines to rid the world of the pertussis bacteria.
In the first section of the text the author will describe the history of the bacteria that cause the whooping cough and exactly what it is comprised of and the toxins that it carries which make the bacteria so deadly and hard to figure out and treat. The signs and symptoms of this disease are very similar to those of the common cold so many people often mistake it as such and do not seek medical advice until it is too late.
The second portion of the text is going to tell you about the recent and past trends of the disease in the United States. The numbers are unpredictable and no one can seem to put a finger on the actual reason why this is, there are a few opinions however. There are a few new vaccines that have been introduced to the world and the hopes are that they will be as helpful as the old vaccine that was given over 50 years ago.

“Whooping cough affects approximately 48.5 million people every year, of whom 295,000 die.” (Nordqvist, 2014) Pertussis is a very severe and highly contagious respiratory disease commonly known as the whooping cough caused by the bacteria Bordetella Pertussis. Until recently it was known as a childhood disease but now it is affecting teens and adults as well as children. In some countries it is called the 100 days’ cough. People with pertussis cough violently and rapidly over and over again causing them to run out of breath and therefore making a loud whooping sound by inhaling hard after running out of breath, hence the name whooping cough.
Bordetella Pertussis is a bacterium that was named after the Belgian microbiologist Jules Bordet. He was the director of the Belgian institute and a Professor of Bacteriology at the University of Brussels. In 1906 he cultivated the B.pertussis and came to the conclusion that it is the cause of what we call the whooping cough. B.pertussis appears singly or in pairs and is a gram-negative aerobic coccobacillus. It is an encapsulated immotile aerobe that does not make spores. This bacterium colonizes the cilia of the mammalian respiratory epithelium. It resides in the upper airways, mostly the trachea and bronchi. At first it was thought that this organism did not attack the tissues but some studies have shown it in the alveolar macrophages.
B. pertussis excretes many deadly toxins like dermonecrotic toxin, tracheal cytotoxin, invasive adenylate cyclase, and a few others. Dermonecrotic toxin causes inflammation and localized necrosis next to where the B. pertussis is actually located. When low doses are emitted it forms in the way of necrosis but if high doses are emitted it is lethal. Tracheal cytotoxin is bad for your respiratory system. It attacks the ciliated cells in the respiratory system and prevents them from beating. Invasive adenylate cyclase acts locally and helps the organism initiate the infection in the patient. It is the agent that causes the whooping cough. The pertussis toxin targets the respiratory tract in promoting the infection. It is a key factor in the early stages. The filamentous hemagglutinin mediates the adhesion of the infection to the host cells, so it is self-explanatory as to why this toxin is deadly. (Todar, 2012)
Humans are the only available host for pertussis. It cannot survive in this environment without its host and must be in small groups or singly. 95 to 98.6 degrees Fahrenheit is the prime temperature for the bacteria to grow so the human body is the ideal host. Pertussis is highly contagious, because of this any one suspecting that they may possibly have pertussis should be checked out by doctor. Pertussis is the most contagious up to about two weeks after the person has begun coughing. The disease is spread by simply by being near an infected person that sneezes or coughs, the bacteria are then released and the non-infected breathe it in.
While pertussis is serious for everyone that is infected it is especially life threatening for young children and infants. The younger the child the harder whooping cough affects them. Hospitalization is usually required for infants below the age of 1. Older people are often the first to get it in the household and then transmit it to the younger children. "Of those infants who are hospitalized with pertussis about: * 1 in 4 (23%) get pneumonia (lung infection) * 1 or 2 in 100 (1.6%) will have convulsions (violent, uncontrolled shaking) * Two thirds (67%) will have apnea (slowed or stopped breathing) * 1 in 300 (0.4%) will have encephalopathy (disease of the brain) * 1 or 2 in 100 (1.6%) will die " (Complications, 2013)
Teens and adults that are diagnosed with whooping cough are not often hospitalized. When this age group is hospitalized it’s usually because their immune system was already compromised or they pass out or bruise and injure their ribs from the violent coughing.
Knowing the early signs and symptoms of whooping cough may save someone’s life. Even with receiving the vaccination there is still a chance that you may get the whooping cough so this is one reason that you should be aware of the signs and symptoms. In the beginning the disease usually starts with cold like symptoms. It starts with a sore throat and the feeling of being tired and sick. Around 2 to 3 days is when the cough will start. It will just be a regular cough further making things seem like they are just a cold. After that is when the coughing will start to get worse and the runny nose and secretions will come.
Even though some may think they are just coming down with a simple cold their not. In a few weeks the coughing will be persistent and get worse. This is when people often go and get checked out by their doctor. By this time the cough can be so bad that it induces vomiting, apnea, and cyanosis (usually in small children) from not being able to breathe. How this happens is that pertussis causes the person to cough violently and rapidly over and over again until all the air is gone from your lungs and you are forced to inhale so hard that it makes the sound known as whooping, hence where the disease gets its name from. After all of this coughing the infected person is usually really exhausted. The violent coughing can last for up to 10 weeks or more and frequently happen more at night time.
In order to diagnose pertussis you need to start with an interview of the patient, just like a regular checkup. A big red flag is when a patient comes in with a cough lasting more than 2 weeks. A nose or throat sample and culture is then done. The doctor would take a swab or suction the nose to get a sample of the secretions. With these samples they can be sent to the lab and checked for the presence of the pertussis bacteria. This test is a sure indicator to diagnose the disease. The only thing about the culture is that it can be affected in a bad way very easily. Simple things like collection, transportation, and isolation techniques may affect the results of the culture. Another type of culture that may be done is a Polymerase Chain Reaction (PCR). This is a rapid culture test that has great sensitivity to the bacteria. The thing with this test is that is has a time frame in which the PCR can be done in order to report accurate results. Blood test and Chest x-rays are also done along with the culture samples. The blood test is just a general test to check the white blood cell counts to see if an infection is present. If the white blood cell count is high then that means the body is trying to fight off an infection. Chest x-rays can show if there is inflammation in the lungs or possibly pneumonia which can happen with pertussis. (Wang, 2011)
Antibiotics are the main treatment for the whooping cough. With early detection and antibiotics the likelihood of the infected person getting better is greater. The administering of antibiotics early helps to stop the spread of the disease and also if given early enough may prevent the patient from having to deal with the coughing fits. Corticosteroids can also be given to the patient in conjunction with the antibiotics if the symptoms are severe enough. These types of steroids are used to help alleviate any inflammation in the airways of the patient to make it easier for them to breath.
Family members that are always around the infected person may be given preventative medications. If the treatment is being done at home then the patient has to be really careful to follow all of the instructions that are given by the physician for the antibiotics. There are a few minor things that one can do to help the patient while they are at home. The family can keep the home free from factors like dust, smoke, and chemical fumes that may induce coughing. If the patient has a lot of secretions that’s making it hard for them to breathe using a cool mist vaporizer may help to break the secretions making it easier to cough up. The patient should also stay hydrated at all times and eat small meals as to not vomit if a coughing fit may happen.
If the treatment is given after the patient has had the infection for three weeks it will not help the patient. After three weeks the bacteria has already done its damage to the body and most likely is gone from the body. However this doesn’t mean that the patient will be rid of their symptoms. Recovery from the whooping cough goes slowly. It is not just a sudden stop of all symptoms; it slows and diminishes over time. Coughing fits may however trigger again if the person contracts some type of other respiratory illness.
Many physicians’ offices give the pertussis vaccine combines with tetanus and diphtheria. Pertussis vaccine is now given to kids from birth during their normal doctor visits. As a teen and adult you just have to get the 10 year booster shot which is usually included in the tetanus and diphtheria vaccine. For pregnant women however it is recommended that they receive the vaccine around 27 to 36 weeks of gestation.
DTaP is the pediatric formula of the vaccine given to children that are 6 weeks of age to 7 years old. Tdap is the version that is given to Teens and adults. They are both a combination of Diphtheria, Tetanus, and Pertussis. The difference is the concentration of the components in the vaccines that makes them for the age groups.
As with everything else in the world there are complications with Whooping Cough. For older children and adults there usually no problems and they recover quickly, however for infants that contract the disease there are some serious complications to include: * Pneumonia * Seizures * Bleeding in the brain * Brain damage * Apnea * Convulsions * Death
The neurological factors happen because of the reduction of oxygen to the body and brain. These are more common for the infants because they are not able to control their bodies as much as adults.
The main prevention for pertussis is to get the vaccination which has been available for over 70 years and because of this vaccine there have been fewer deaths. “Before vaccines, approximately 157 people per 100,000 developed whooping cough in the USA (reported cases). There were peaks every two to five years. In 93% of cases, they were children under 10. Experts say the real incidence at that time was much higher (not all cases were reported). After the introduction of mass vaccinations in the 1940s, whooping cough rates dropped to less than 1 per 100,000 by 1970. However, since 1980 numbers have started to creep back up slightly.” (Nordqvist, 2014)
There is no clear reason why there has been a rise in the amount of cases since the late 1980s. Many thought that with the new vaccine that was introduced in the 1990s the rates of infection would decrease, but surprisingly they spiked. There are a few different opinions on why the increase has happened but no one can be for certain the true cause. Some think that it is because human’s immunity has decreased overtime and the vaccination that they received as a child has probably wore off to an extent. Others think it’s because the parents who don’t allow their kids to be vaccinated are making it so that they contract the disease and infect others. Then there are those that believe that the newer whooping cough vaccine is not protecting against the pertussis bacteria as long as the old vaccine was. I personally believe that they are all factors in the outbreak, and also I believe that even if you receive the vaccine there is still a chance that you make catch the bacteria.
Every year around 16 million people worldwide get pertussis and about 195,000 people die from it. Since the 1940s when the vaccination has become available for children the number of deaths and recordable events dropped 75 percent. (Konkel, 2015) The pertussis vaccine used before the late 1990s was a type of vaccine known as the whole cell vaccine, meaning it used all parts of the bacteria that causes the whooping cough. This type of vaccine is effective but it has a few side effects including sore arms, anxiety, fussiness, and seizures. The new version of the pertussis vaccine is known as the acellular vaccine, which contains only parts of the bacteria. This version also has fewer side effects than the whole cell vaccine. “At first, “the data showed that acellular worked as well as whole cell,” Tan says. “But as time went on, immunity just started waning in children who got the acellular vaccine.” (Parch, 2014)
Pertussis outbreaks are very tricky to manage and track. The reason for this is because the signs and symptoms are so close to those of the flu and common cold, therefore the flu or common cold is often mistaken for the whooping cough. Even though there is a culture done to verify the Pertussis bug, sometimes there are false positives because of other bacteria that the patient may have. This contributes to the reasoning behind how hard it is track the pertussis disease at times.
In California the rates of infection have not been stable. Some years its down and others the numbers are up. There is no huge explanation for this and experts are still trying to find out the reasoning. In 2012 the number was merely 1023 and then in 2014 made a drastic jump to 11,203. Out of the cases reported in 2014 only 456 cases were hospitalized and three deaths were reported. All three deaths were infants who were less than 5 weeks old.
For the CDC there have been some trends that have been noticed. 28,660 cases have been reported during 2014, this is about an 18% percent increase from the numbers that were reported in 2013. Another trend that seemed apparent is the ages of the people that are being infected. The numbers from the years 2014 were comparable to those of the years 2013 and 2012. “Overall reporting of pertussis declined during 2013 after a peak year in 2012. During 2012, 48,277 cases of pertussis were reported to CDC, including 20 pertussis-related deaths. This was the most reported cases since 1955.” (Pertussis Outbreak Trends, 2015)
Pertussis or the whooping cough as some may call it is a serious illness especially if you are around children a lot. If you have small children at home beware of their sniffles and coughs to ensure that they are not coming down with the whooping cough. No one likes to always have to go into the doctor’s office every time they feel that they are getting the sniffles but you can never be too careful. The rise in Pertussis is scary for everyone but with the necessary preventative methods like handwashing for instance you can help lower risk of contracting the disease.

Bibliography
Complications. (2013, January 15). Retrieved June 22, 2015, from http://www.cdc.gov/pertussis/about/complications.html Jenkinson, D. (2015, April). whooping cough | specialist |. Retrieved June 22, 2015, from http://www.whoopingcough.net/symptoms.htm
Konkel, L. (2015, April 27). Whooping Cough: Outbreaks and Trends. Retrieved July 5,
2015, from http://www.healthline.com/health/new-baby-vaccination-guide/whooping-cough-outbreaks-and-trends
Nordqvist, C. (2014, September 16). What is whooping cough? What is pertussis?
Retrieved June 22, 2015, from http://www.medicalnewstoday.com/articles/257706.php
Parch, L. (2014, January 7). Why Whooping Cough Is Rising Despite a New Vaccine.
Retrieved June 24, 2015, from http://www.webmd.com/children/vaccines/features/whooping-cough-rising-despite-new-vaccine
Pertussis Outbreak Trends. (2015, March 11). Retrieved July 5, 2015, from http://www.cdc.gov/pertussis/outbreaks/trends.html Todar, K. (2012). Bordetella pertussis and whooping cough. Retrieved from http://textbookofbacteriology.net/pertussis.html Wang, L. (2011, July 4). Bordetella pertussis - MicrobeWiki. Retrieved June 23, 2015, from https://microbewiki.kenyon.edu/index.php/bordetella_pertussis