The Perils of Pertussis

As I walked up to the circulation desk where my daughter was showing her independence by checking out her stack of books about hamsters, kangaroos, Australia, and the solar system by herself and with her own library card, I heard her say to the librarian, “…because my brother has percussis.”

The librarian looked at my daughter over the lenses of her glasses then glanced quickly at me and then at my son reading books on the floor before looking back at the books she was scanning.

“It’s pertussis, honey,” I addressed my daughter loudly enough for the librarian to hear. “And we’ve finished all of our antibiotics so we’re not contagious anymore.”

We followed the standard protocol for pertussis as soon as my son started whooping last week. Everyone in the family went on antibiotics to help kill the bacteria and prevent its spread from us to 48 to 60 other people (one person with pertussis can infect 12-15 others). It appears that none of the rest of us is developing the cough; whether I can credit our vaccines or the antibiotics for that, I don’t know. My little boy is still hacking and whooping even though we’ve been done with our antibiotics for two days, but we expected this. When started after the cough begins, the antibiotic kills the bacteria but doesn’t stop the progression of the disease because the damage to the airways has already been done.* The cough just needs to run its course. And that can take weeks.

After we were confident we were no longer contagious, we started going out in public again, but I still have to carry a towel with me in case my son has a coughing fit (or paroxysm, as they’re called) and needs to wretch up thick, stringy mucus in the middle of Whole Foods. I pick him up as soon as he starts to cough because otherwise he’s on the floor; he can’t hold himself up while he’s trying to breathe. Sometimes, although he’s been in big-boy underpants for months now, he wets himself while he’s coughing.

And in between coughing fits, he acts fine. He has energy; he’s happy. People don’t believe me when I say he’s sick.

“He’s got a lot of energy for a kid who’s sick,” they say dubiously.

“Just wait,” I think.

If we’re still nearby when my son starts coughing, their dubious expression turns to shock.

It’s taken me a while to get my head around the idea that, in spite of being vaccinated, my three-year-old got pertussis. I knew that the DTaP vaccine isn’t as effective as the DTP my husband and I got as children, but I guess I just thought that my children had adequate protection against the illness.

Being up most of the night every night for more than a week with a child with a “mild” case of whooping cough—a child who coughed so frequently he couldn’t catch his breath, a child who coughed so hard he would throw up, who coughed so hard he broke a blood vessel in his eye, who writhed and cried as he hacked his way through a 30-minute coughing fit one night—left me feeling very alone. I felt even more alone when people assumed that he would be well after a couple of days. Not that I could blame the people who didn’t understand; I knew pertussis was bad, but until I saw it for myself, I really had no idea.

It was helpful to exchange e-mail with my friend who had pertussis this summer; she not only understood what we were going through, she could also help me understand what my son might be feeling. Although his verbal skills are admirable for a three-year-old, he’s not very eloquent at describing what’s going on in his little body. My friend’s feedback helped give me an idea of what else I could do to help him. For example, I stopped giving him the cough suppressant our doctor prescribed to help him sleep at night when my friend described feeling like she was suffocating when she used a cough suppressant; she still had the need to cough, but she just couldn’t. It was just the concern I’d had when I saw how he acted on the medication, but I couldn’t tell for sure what he was feeling.

There was a fleeting moment at the beginning of our pertussis journey when I thought, “Why did we even bother to vaccinate if we were going to get this anyway?” But after doing some more research on the CDC website and e-mailing with my epidemiologist friend, I feel even more confident about vaccinating my family against pertussis than I did before. The vaccine, while imperfect, is really the best defense against this illness. Once the coughing starts and you can get a diagnosis (assuming the symptoms are “classic” and pertussis is even suspected), you’ve already been contagious for 7 to 10 days. Sometimes it can take as long as six weeks for the cough to develop. The best you can do is start antibiotics for all household members and hope it doesn’t spread any further. And that’s if you get a diagnosis. Many vaccinated individuals who get pertussis get a milder case and don’t present with “classic” symptoms. Some never “whoop” at all.† Given all of this, it’s difficult to tell just how many cases of pertussis go undiagnosed each year.

In a way that’s comforting, though. It means that the vaccine helps even if it doesn’t prevent the illness in every individual. Seeing my son’s “mild” case is one of the things that made me feel grateful I’d vaccinated him. If this is mild, I have no desire to see what a moderate or severe case looks like.

It’s important to note that, while the CDC strongly supports vaccination, even that body does not blame the increase in pertussis rates and epidemics on unvaccinated children. According to the CDC website, the rate of reported pertussis infection has been on the rise since 1980, and it’s been picking up speed since the early 1990’s when the whole-cell DTP vaccine was replaced with the acellular DTaP vaccine. It seems that the DTaP vaccine is simply less effective than previously thought. The immunity wanes faster than they realized, leaving the children for whom there is no approved vaccine more vulnerable to pertussis infection. Even if I wanted to get my 7-year-old an extra booster after this brush with pertussis (which may well be unnecessary since she’s been exposed to the real thing and hopefully that served as her “booster”), there’s no vaccine approved for her age group. She’s too old for the DTaP and too young for the Tdap.

So, I’ll get my son his last DTaP booster and I’ll get myself the Tdap and hope we never, ever have to deal with this illness again, mild or otherwise. In the meantime, I’ll lay my son in his bed and wait for his first coughing fit of the night.

*CDC website, Pertussis: Diagnosis and Treatment.

†CDC website, Pertussis: Signs and Symptoms.

Related articles

• Whooping Cough Outbreak: Top 10 Things You Should Know (pbs.org)
• Whooping Cough Vaccine Diminishes After 5th Dose (news.brevardtimes.com)
• Whooping Cough Outbreak: CDC Answers Your Questions (pbs.org)
• Whooping Cough Shots Questioned (wsj.com)

(Incidentally, I think it’s a funny coincidence that we discovered that my vaccinated son had pertussis the same week the article about waning efficacy of the DTaP vaccine came out. I didn’t hear about that article until yesterday, so it did not influence my decision to take him to the doctor.)