Preface
This isn’t the sort of content I usually put in this blog, but I think it is important content to get the word out, and I want a wide distribution, so I am putting it in my blog that gets a wider readership. It seems to me, that this is part of the role and responsibility of being active in healthcare social media.
My entire family had whooping cough in December. Being a medical librarian, I went out and learned about it. I learned some very interesting things. Since then, I have been astonished how many people I have met who were going through having whooping cough without even knowing that was what they had, which resulted in some surprising conversations. Here I hope to share some of the misunderstandings and assumptions that I’ve encountered, and which may be contributing to the local spread of this disease.
I am a librarian and not a doctor, so I welcome comments or clarifications from real healthcare professionals.
What Grownups Think They Know About Whooping Cough (But Don’t)
Washtenaw County Public Health Department (screenshot)
1. “We don’t have any more whooping cough in the USA.” “Didn’t they wipe that out?”
There are epidemic levels of whooping cough (a.k.a. pertussis, a.k.a. Bordetella pertussis) in many places throughout the United States. California has a particularly bad situation right now, but we have a declared epidemic locally, right here in Washtenaw Country.
2. “I’ve been vaccinated, so I’m safe, right?” “But I had this before, so I can’t catch it again.”
The whooping cough (pertussis) vaccine or immunity from having it only lasts 5 to 10 years, so even if you have been vaccinated you may be vulnerable or need a booster. Even if you have a current booster, the protection is not a 100% guarantee, but only an 85% guarantee. Doctors recommend treating all the in-home relatives of people with a confirmed diagnosis, even if they’ve been vaccinated.
3. “All I have is a cold.”
Most people who get whooping cough don’t know they have it. In adults, whooping cough often looks like a cold, and people don’t realize that they have something else until after they have been sick for a couple weeks already. At that point, the antibiotics don’t provide a full cure, and they have already infected everyone around them. This is HIGHLY contagious. Around 90% of people who are exposed and not vaccinated will catch it. In my family it was 100%. Experts believe that only 5-10% of whooping cough cases are ever diagnosed and reported. You need to go to the doctor sooner rather than later. Don’t wait too long! The Chinese call this the “100-day cough” for a reason.
4. “But my cough doesn’t go whoop, so it isn’t whooping cough.”
In adults, they may not ever develop the typical cough that has the whoop, and may only get a ‘normal’ cough. Even with kids, they might not get the whoop to their cough until after the first couple weeks of being ill. This makes it harder to find out what illness they have. This is not easy to diagnose, so don’t guess yourself, let the doctor figure it out. By the time the whoop shows up you’ve waited too long. You endanger those around you, and this does kill people, especially very young babies.
5. “But no one I know has whooping cough, so it can’t be that.”
Whooping cough is all through the public schools in our area. If you know any children, visit people who have children, work with people who have children, ride the bus, go to church, attend public performances or events, you have probably been exposed. After you’ve been exposed, symptoms usually start about a week later, but can start anytime from 3 days later to 21 days, sometimes even up to 42 days! Basically, you don’t know if you’ve been exposed.
6. “If I didn’t go to the doctor early enough, then it doesn’t make any difference. I’ll just tough it out and take cough syrup.”
Antibiotics work best during the first two weeks of the illness, providing both cure and preventing spread of the disease. After that, the damage has mostly been done by the condition, but you can still help keep other people safe. People who may have whooping cough should go to the doctor as soon as they become ill, even if they aren’t sure. This helps protect those around them and prevent spread of the disease. Everyone they live with should also be given the antibiotics, even if they were vaccinated. The Department of Public Health recommends that you stay home for the first 5 days you are on antibiotics. They also mention that cough syrup isn’t very helpful and they don’t recommend it.
7. “We don’t have to worry here. If there was a problem, surely they would tell people.”
The whooping cough epidemic information was posted to the Washtenaw County Department of Public Health last summer, in June and July. Announcements in the various news publications were repeated in June, July, September, November, and December. Notice was sent home from my son’s school in October. It was posted to the Facebook page or Twitter streams for the County Public Health Department, Michigan Disease Surveillance System, Packard Health, Village Pharmacy, and probably more.
Don’t blame yourself for not seeing them. I missed this, too. But now that we know, let’s spread the word. Word of mouth works best.
WARNING SIGNS
* A tickle in the back of your throat, that spreads up and down from the starting spot
* Runny nose
* Stuffy nose
* Sneezing
* Red, itchy or watery eyes
* A mild fever, or no fever
* Dry cough
DO
* See a doctor FAST if you get something that looks like a cold, especially if you’ve been around kids or will be.
* Stay home if you aren’t sure yet whether you have whooping cough, and for the first 5 days of antibiotics. This is to keep others safe.
* Take all the medication you’ve been given, exactly the way the doctor told you.
* Drink lots of fluids, especially honey with lemon in hot water.
* Encourage your friends and coworkers to stay home if they are sick and see a doctor if there is any doubt at all about whether they have whooping cough or not.
DON’T
* Don’t tough it out.
* Don’t go to work or school with anything that seems like a cold.
* Don’t go visit friends or go to church or school or parties.
SOURCES
1. Washtenaw County Public Health: Pertussis (Whooping Cough) at Epidemic Levels: http://www.ewashtenaw.org/government/departments/public_health/news/2010-news-stories/pertussis-whooping-cough-cases-at-all-time-high
2. National Foundation for Infectious Diseases: Whooping Cough (pertussis): http://www.adultvaccination.org/whooping_cough_vaccine_pertussis_vaccination_adult_immunization.htm ; New York State Department of Heatlh: Pertussis (whooping cough): http://www.health.state.ny.us/diseases/communicable/pertussis/fact_sheet.htm
3. Bocka, Joseph J. Pediatrics, Pertussis. eMedicine, May 26, 2009. http://emedicine.medscape.com/article/803186-overview
4. CDC: Pertussis (Whooping Cough) – What You Need To Know: http://www.cdc.gov/Features/Pertussis/ ; Mayo Clinic: Whooping Cough: Symptoms: http://www.mayoclinic.com/health/whooping-cough/DS00445/DSECTION=symptoms ; healthfinder: Health Tip: Does Your Child Have Pertussis?: http://www.healthfinder.gov/news/newsstory.aspx?docID=641831
5. Ann Arbor Public Schools: Pertussis (Whooping Cough) on the Rise in Washtenaw County: http://www.a2schools.org/aaps.news/news___events#pertussis
6. MedlinePlus: Pertussis: http://www.nlm.nih.gov/medlineplus/ency/article/001561.htm
MORE INFORMATION (Washtenaw County Public Health):
Parents & Caregivers of Infants:
http://www.ewashtenaw.org/government/departments/public_health/news/2010-news-stories/protect-infants-from-pertussis
Parents & Caregivers of School-Age Children:
http://www.ewashtenaw.org/government/departments/public_health/news/2010-news-stories/protect-school-age-children-from-pertussis
Healthcare Providers:
http://www.ewashtenaw.org/government/departments/public_health/news/2010-news-stories/pertussis-flyer-for-health-care-providers
LOCAL HEALTH SOCIAL MEDIA CHANNELS (selected)
Twitter: WC Public Health: http://twitter.com/wcpublichealth
Twitter: Washtenaw County: http://twitter.com/WashtenawCounty
Twitter: U-M Health System: http://twitter.com/umhealthsystem
Facebook: Washtenaw Country Public Health Department: http://www.facebook.com/pages/Ypsilanti-MI/Washtenaw-County-Public-Health-Dept/306407418528
Facebook: Michigan Disease Surveillance System: http://www.facebook.com/pages/Michigan-Disease-Surveillance-System/498881265477
Facebook: University of Michigan Health System: http://www.facebook.com/UniversityofMichiganHealthSystem?v=info
Facebook: Packard Health: http://www.facebook.com/pages/Packard-Health/191643863989
Facebook: Village Pharmacy II: http://www.facebook.com/pages/Village-Pharmacy-II/155288804501668
Emerging Technologies Librarian 
Went for annual checkup yesterday (well, it’s been over 2 years so let’s say biennial checkup), and the physician was very careful and concerned about the whooping cough issue–asked me twice whether I had or will have contact with babies or little children, in which case he would have directed me to have a pertussis inoculation. I was impressed by his emphasis of this disease.
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From what I have seen, the medical community is VERY aware of this. Many people have told me they went to the doc for a cold, and received antibiotics (azithromycin or amoxicillin), which is not typical for colds. However, the people taking the meds don’t understand why they are taking them, and the general public is not commonly aware of this issue here. I am hoping that more folks will take this seriously and go to the doc if they have symptoms.
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Thanks for this information. Prior to reading, I knew nothing about whooping cough. Now I know what to look out for.
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So glad it was useful! Spread the word, so other folks know as well.
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I have a friend whose newborn died from Pertussis several years ago. Prior to this, I had no idea it had resurfaced in the US. Because of her tragedy, I got my Pertussis booster (not 100%, but a lot better than nothing) and educated myself on the warning signs. It’s turned out to be pretty handy since I work in a pharmacy.
Thanks for sharing your knowledge. Anything we can do to get the word out is so important!
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Absolutely agreed. My kids are allergic to the vaccine, so we weren’t protected. Scary.
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As a “real” healthcare professional, I want to thank you for writing about whooping cough. Your information is all spot on and I hope it spurs your readers to go get their Tdap booster vaccines. It’s so important for all of us to keep our immunity high to protect the most vulnerable among us–the babies too young to be immunized themselves. Educating people on how to stop the spread of disease is a challenge we face in the public health arena every day. Thank you for helping us increase awareness and thanks, too, for recognizing NFID and its website, adultvaccination.org, as a useful source of sound scientific information. William Schaffner, M.D. President, National Foundation for Infectious Diseases
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Hurray! Thank you so VERY MUCH for your kind and authoritative comment. I always feel better when a real doctor looks over the info. Very much appreciated!
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Hi there, I have stumbled across this whilst searching pertussis. I was diagnosed with pertussis 4 months ago via blood test results… My doc was not specifically looking for pertussis. I wonder if in your research you came across people being diagnosed with pertussis without any cough at all?? I am not convinced my diagnosis is correct as I had no cough what so ever….
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For the record, I am a librarian, not a doctor, and these are great questions for doctors. You might want to ask at MedHelp, http://www.medhelp.org/ , perhaps?
First question. Even if you had pertussis, you would be long over it by now. The symptoms usually last about 3 months, but the actual infection is usually over long before that. So I’m a little puzzled why you would be concerned about it at this late date. Next question is what does diagnosis mean in this case. Did they diagnose AND treat? Meaning, did the doctor prescribe antibiotics for the pertussis? That would be a little surprising, but the doc may have been prescribing antibiotics for something else they found.
You mention that the doc was running a bunch of blood tests. That would seem like a hint that something was wrong, even if they weren’t sure what. One of the core concepts in primary care is not so much diagnosis as managing symptoms. If the docs can come up with something that manages your problems and seems to make things better, often people don’t worry about whether or not the actual diagnosis was correct or not. The point is that you feel better!
I think the main concept you are describing would be about whether the test can be wrong, does it have false-positive and false-negative. This is actually not unusual with pertussis. Most tests have some times when they are wrong. Either they say you have the disease and you don’t, or it says you don’t when you do. The trick with diagnosing pertussis is that there are the symptoms of the infection, then there is what can be called an atypical infection, and then there are the various tests. I am over simplifying here, so take this with a grain of salt. If you have been exposed, have symptoms, and have a positive test, then you probably have it and should be treated. If you have not been exposed, don’t have symptoms, and have a positive test, then you probably don’t have it. If you don’t have symptoms and have not been exposed, you probably should not be tested OR treated.
US CDC: Flow Chart for Pertussis Testing, Treatment and Chemoprophylaxis in an Outbreak Setting
Click to access protocol_amended.pdf
That sounds easy, but people can easily be exposed and not know it. Here in Michigan we had an epidemic for 3 years, and most people didn’t know it. For myself and my son, we sort of flipped this backwards from what you are describing. We were exposed, we were in the middle of the epidemic, we had symptoms, but our tests were negative. Our doctors were smart. They treated us without requiring that the test be positive. So our tests were a false negative. In your case, the question is with no cough but a positive test, do you have the disease? According to the standard guidelines, probably not.
“NOTE: A PCR positive result in a person without a cough is NOT a case.”
US Army: Pertussis Testing, Treatment and Chemoprophylaxis in an Outbreak Setting
Click to access DOH-FS018%20Pertussis%20Flow%20Chart.pdf
So, what if the test WAS wrong? How does that happen? Here is an explanation I found. Basically, it says there are lots of reasons why a test can come back saying you have something you don’t, and one reason is that you might have a different bug that is similar in some way to the bug the test looks for.
“Large pseudo-outbreaks of pertussis have been reported as a result of false-positive PCR test results. False-positive PCR test results may be the result of laboratory error or, as in our case, the use of a nonspecific PCR that detects a closely related bacterial species. Healthcare facilities should adhere to proper laboratory procedures when developing and using PCR tests to diagnose pertussis, especially when the standardized kits approved by the US Food and Drug Administration are not available. Only patients with symptomatic pertussis should be tested, and positive test results using nonspecific primers should be confirmed by direct sequencing or a second PCR test that targets a different region of the genome.”
Weber DJ, Miller MB, Brooks RH, Brown VM, Rutala WA. Healthcare Worker with “Pertussis”: Consequences of a False-Positive Polymerase Chain Reaction Test Result. Infection Control and Hospital Epidemiology March 2010 31(3):306-307.
Click to access ICHE-2010-Mar-p306.pdf
Now, REMEMBER, your doctor was looking to fix a problem, and I have no idea what that was. So, while I can give information about the question you asked, chances are that if we looked at the big picture of everything your doc looked for, and what he did, chances are he or she was probably doing the right thing to try to help you. So, ask your doctor. And if you can’t ask your doctor, ask a different doctor. But at this point, you probably don’t need to worry about pertussis.
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thanks for that. im going to see a doc as a result of your advice.
it cant hurt me.
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That’s great! It helps the people around you safer, and might help you, too! I wish you the best.
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I’m presently suffering from whooping cough and found your article. I appreciate you posting it. I’ve begun a similar one which I linked in the website section but just in case it doesn’t link there here it’s is:
I will be updating my article as I complete this “journey” but I must say I’m jealous. Even though my blood test came back positive AND I recorded me whooping for my doctor to hear, he’s not 100% convinced I have it ?!?
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My doc didn’t really believe us either, but since we had an epidemic in the locale and documented exposure to a diagnosed patient in the public schools, that made things a little easier. Getting the antibiotics was important for us. I try to avoid them, but sometimes, wow.
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One of my doctors believed that I had contracted whooping cough in 2009. By the time he saw me, my primary care doctor had already given me antibiotics, so there was no way to test me for it. I was working with child care providers and their kids, and one of the providers was wildly ill when I went to work with her on site. Whatever I caught, it progressed to pneumonia and then to pancreatitis. I had two cracked ribs by the end of it all, and I had lost months of my life to illness. Oh, and the super fun part was that my employer believed I was making it all up. She didn’t think anyone got whooping cough anymore. This was in Washington State, where whooping cough outbreaks are not uncommon.
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Dana, I’ve been surprised how many folk here have had whooping cough but didn’t believe it. And we had a posted epidemic!
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I was also bullied out of my job by that supervisor, so the illness cost me my livelihood as well.
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I had a boss who tried to do that, and narrowly kept my position. Every since, I’ve been worried about the risk of taking medical leave for any kind of serious problem or surgery. And someone I know just had that happen – had surgery, came back, and was fired the first day back. Happens enough to scare me.
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