Measures to decrease whooping cough risk

Last fall, a baby in Sonoma County died of whooping cough. Only 1 month old, this baby was not yet big enough to be immunized and was exposed to someone who spread the disease. This death was a heartbreaking tragedy, but the good news is that we can easily and inexpensively decrease the risk of whooping cough in our community.

Whooping cough (pertussis) develops over a two-week period, initially causing symptoms of sore throat, fatigue and a dry "normal" cough. There might be a runny nose, and the fever, if present at all, will be mild. But after one or two weeks, occasional bouts of severe but short lived coughing will start to occur. The actual "whooping" sound is present only half of the time. This cough may last for weeks or even months, which is why the Chinese call pertussis "the 100-Day cough."

Your doctor may not readily diagnose whooping cough because your lungs remain clear to an examination with a stethoscope. That is why most cases in adults remain infectious for all those weeks and easily spread to others. But if the infection is accurately diagnosed with a simple culture, antibiotics effectively treat it.

What about the babies and children exposed to pertussis during weeks of contact with an adult who has an undiagnosed infection? Especially those who have not been immunized? They are at great risk, and in them the disease can be deadly.

Sonoma County has an extremely high rate of "personal belief exemptions" for childhood immunizations. Many parents believe that immunizations carry more risks than benefits, and they keep their children healthy through alternative and "natural" methods. Parents educate themselves, reading about statistics that blame the rising rates of autism, asthma and attention deficit disorder on childhood immunizations. Distrustful of Western medicine, the families of unimmunized children in effect depend on the protection of others who have been vaccinated.

My careful review of studies that implicate immunizations with chronic health problems find that they are flawed in their design. These studies fail to take into account other possible factors like our changing environment, both in water and air quality, and changes in the food we eat. I continue to review the information about this issue and remain convinced that selective, thoughtful immunization has more benefits than risks. This is certainly true when it comes to whooping cough.

Immunizations for pertussis do not contain the disease itself. They are not even whole cells. Instead, only specific proteins that are known to play a part in natural immunity are used. This is safer than the original vaccine that was known for side effects like localized swelling, fever and irritability. Before the vaccine was introduced, about 5,000 people died of whooping cough each year. But between 2000 and 2005, there were only 21 pertussis deaths in California and all of these were in infants too young to be vaccinated.

Simple measures can reduce the risk of whooping cough among babies. First, infants less than 2 months old should be physically protected from community acquired infections. Avoid passing new babies around for everyone to hold, cuddle and kiss. As sweet as it is to show off and share your baby, it's just not safe to expose him to the general public. And remember, your new baby has spent her whole existence so far in a dark, warm, quiet environment. Too much stimulation can cause crying and irritation that is hard to calm.

The childhood pertussis vaccines do not provide lifelong protection, so individuals between the ages of 10 and 64 should get booster shots, especially if they anticipate close contact with very young babies. This is an extremely effective and inexpensive way to protect the community; if we can decrease infection in adults, we can decrease the spread to babies.

I encourage you to see your physician, or take advantage of the Sonoma County Public Health immunization clinic. Get a pertussis booster to protect yourself, your community, and most importantly, those you love.

Dr. Stacey Kerr, a longtime Sonoma County family physician, graduated from UC Davis Medical School and is certified in her specialty by the American Board of Family Medicine. Her columns are not intended as a substitute for hands-on medical advice or treatment. Consult your health care provider before adhering to any recommendations in this column. E-mail comments to drkerr@the-doctors-inn.com.