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Whooping cough – or pertussis – is an infection of the respiratory system caused by the bacterium Bordetella pertussis (or B. pertussis). It’s characterized by severe coughing spells that end in a “whooping” sound when the person breathes in. Before a vaccine was available, pertussis killed 5,000 to 10,000 people in the United States each year. Now, the pertussis vaccine has reduced the annual number of deaths to less than 30.
It is an upper respiratory infection and is a serious disease that can cause permanent disability in infants, and even death.
Pertussis was recognizably described as early as 1578 by Guillaume de Baillou (1538-1616), but earlier reports date back at least to the 12th century. B. pertussis was isolated in pure culture in 1906 by Jules Bordet and Octave Gengou, who also developed the first serology and vaccine. The complete B. pertussis genome of 4,086,186 base pairs was sequenced in 2002.
In recent years, the number of cases has started to rise. By 2004, the number of whooping cough cases spiked past 25,000, the highest level it’s been since the 1950s. It’s mainly affected infants who are younger than 6 months old before they are adequately protected by their immunizations, and kids who are 11 to 18 years old whose immunity has faded.
Although whooping cough can occur at any age, it’s most severe in unimmunized children and in infants under 1 year of age (early immunization can usually prevent this serious disease in babies). But more cases have been reported in teens and adults, because their immunity has faded since their original vaccination. That’s why the American Academy of Pediatrics (AAP) recently recommended that kids who are 11-18 years old get a booster shot that includes a pertussis vaccine, preferably when they are 11 to 12 years old.
The incubation period (the time between infection and the onset of symptoms) for whooping cough is usually 7 to 10 days, but can be as long as 21 days.
The first symptoms of whooping cough are similar to those of a common cold:
After a 7 to 10 day incubation period, pertussis in infants and young children is characterized initially by mild respiratory infection symptoms such as cough, sneezing, and runny nose (catarrhal stage). After one to two weeks, the cough changes character, with paroxysms of coughing followed by an inspiratory “whooping” sound (paroxysmal stage). Coughing fits may be followed by vomiting due to the sheer violence of the fit. In severe cases, the vomiting induced by coughing fits can lead to malnutrition. The fits that do occur on their own can also be triggered by yawning, stretching, laughing, or yelling. Coughing fits gradually diminish over one to two months during the convalescent stage. Other complications of the disease include pneumonia, encephalitis, pulmonary hypertension, and secondary bacterial superinfection.
Because neither vaccination nor infection confers long-term immunity, infection of adolescents and adults is also common Most adults and adolescents who become infected with Bordetella pertussis have been vaccinated or infected years previously. When there is residual immunity from previous infection or immunization, symptoms may be milder, such as a prolonged cough without the other classic symptoms of pertussis. Nevertheless, infected adults and adolescents can transmit the bacteria to susceptible individuals. Adults and adolescent family members are the major source of transmission of the bacteria to unimmunized or partially immunized infants, who are at greatest risk of severe complications from pertussis.
After about 1 to 2 weeks, the dry, irritating cough evolves into coughing spells. During a coughing spell, which can last for more than a minute, the child may turn red or purple. At the end of a spell, the child may make a characteristic whooping sound when breathing in or may vomit. Between spells, the child usually feels well.
Although it’s likely that infants and younger children who become infected with B. pertussis will develop the characteristic coughing episodes with their accompanying whoop, not everyone will. However, sometimes infants don’t cough or whoop as older children do. They may look as if they’re gasping for air with a reddened face and may actually stop breathing for a few seconds during particularly bad spells.
Adults and adolescents with whooping cough may have milder or atypical symptoms, such as a prolonged cough without the coughing spells or the whoop.
Pertussis can cause prolonged symptoms. The child usually has 1 to 2 weeks of common cold symptoms first. This is followed by approximately 2 to 4 weeks of severe coughing, though the coughing spells can sometimes last even longer. The last stage consists of another several weeks of recovery with gradual resolution of symptoms. In some children, the recovery period may last for months.
Pertussis is highly contagious. The bacteria spread from person to person through tiny drops of fluid from an infected person’s nose or mouth. These may become airborne when the person sneezes, coughs, or laughs. Other people then can become infected by inhaling the drops or getting the drops on their hands and then touching their mouths or noses. Infected people are most contagious during the earliest stages of the illness up to about 2 weeks after the cough begins. Antibiotics shorten the period of contagiousness to 5 days following the start of antibiotic treatment.
Because the symptoms during the catarrhal stage are nonspecific, pertussis is usually not diagnosed until the appearance of the characteristic cough of the paroxysmal stage. Methods used in laboratory diagnosis include culturing of nasopharyngeal swabs on Bordet-Gengou medium, polymerase chain reaction (PCR), immunofluorescence (DFA), and serological methods. The bacteria can be recovered from the patient only during the first three weeks of illness, rendering culturing and DFA useless after this period, although PCR may have some limited usefulness for an additional three weeks. For most adults and adolescents, who often do not seek medical care until several weeks into their illness, serology is often used to determine whether antibody against pertussis toxin or another component of B. pertussis is present at high levels in the blood of the patient.
Treatment with an effective antibiotic shortens the infectious period but does not generally alter the outcome of the disease; however, when treatment is initiated during the catarrhal stage, symptoms may be less severe. Three macrolides, erythromycin, azithromycin and clarithromycin are used in the U.S. for treatment of pertussis; trimethoprim-sulfamethoxazole is generally used when a macrolide is ineffective or is contraindicated. Close contacts who receive appropriate antibiotics (chemoprophylaxis) during the 7â€“21 day incubation period may be protected from developing symptomatic disease. Close contacts are defined as anyone coming into contact with the respiratory secretions of an infected person in the 21 days before or after the infected person’s cough began.
Some children with whooping cough need to be treated in a hospital. Infants and younger children are more likely to be hospitalized because they’re at greater risk for complications such as pneumonia, which occurs in about one in five children under the age of 1 year who have pertussis. Up to 75% of infants younger than 6 months old with whooping cough will receive hospital treatment. Infants and younger children are more likely to require hospitalization because they’re at greater risk for complications such as pneumonia, ear infection, dehydration, and seizures. In infants younger than 6 months of age, whooping cough can even be life-threatening.
While in the hospital, a child may need suctioning of thick respiratory secretions. The child’s breathing will be monitored, and oxygen may be needed. Intravenous (IV) fluids might be required if the child shows signs of dehydration or has difficulty eating. The child also will be isolated from other patients, with special precautions taken to prevent the infection from spreading to other patients, hospital staff, and visitors.
If your child is being treated for pertussis at home, follow the schedule for giving antibiotics exactly as your child’s doctor prescribed. Giving your child cough medicine probably will not help, as even strong cough medicines usually can’t relieve the coughing spells of whooping cough.
During recovery, let your child rest in bed and use a cool-mist vaporizer. This will help loosen respiratory secretions and soothe irritated lungs and breathing passages. (If you use a vaporizer, be sure to follow directions for keeping it clean and mold-free, usually with small amounts of bleach.) In addition, try to keep your home free of irritants that can trigger coughing spells, such as aerosol sprays, tobacco smoke, and smoke from cooking, fireplaces, and wood-burning stoves.
Children with whooping cough may vomit or not eat or drink as much because of frequent coughing. So offer smaller, more frequent meals and encourage your child to drink lots of fluids. Watch for signs of dehydration too, including: thirst, irritability, restlessness, lethargy, sunken eyes, a dry mouth and tongue, dry skin, crying without tears, and fewer trips to the bathroom to urinate (or in infants, fewer wet diapers).
Home Remedy: Sunflower seeds have diuretic as well as expectorant properties, and thus have been used successfully for the treatment of bronchial ailments such as bronchitis, coughs, colds, and whooping cough. Modern homeopathic use for Sunflowers includes treatment foren ailments, intermittent fever, nosebleed, nausea, and vomiting. A tea of the toasted seed may be used for whooping cough. The leaves are often included in herbal tobacco mixtures.
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Whooping cough can be prevented with the pertussis vaccine, which is part of the DTaP (diphtheria, tetanus, acellular pertussis) immunization. DTaP immunizations are routinely given in five doses before a child’s sixth birthday.Pertussis vaccines are highly effective, strongly recommended, and save countless infant lives every year. Though the protection they offer lasts only a few years, they are given so that immunity lasts through childhood, the time of greatest exposure and greatest risk. To give additional protection in case immunity fades, the AAP now recommends that kids ages 11-18 get a booster shot of the new combination vaccine (called Tdap), ideally when they’re 11 or 12 years old, instead of the Td booster routinely given at this age. As is the case with all immunization schedules, there are important exceptions and special circumstances. Your child’s doctor will have the most current information.
Experts believe that up to 80% of nonimmunized family members will develop whooping cough if they live in the same house as someone who has the infection. For this reason, anyone who comes into close contact with a person who has pertussis should receive antibiotics to prevent spread of the disease. Young children who have not received all five doses of the vaccine may require a booster dose if exposed to an infected family member.
The tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) – will replace the Td (tetanus and reduced diphtheria toxoids) vaccine in the childhood immunization schedule. The Td vaccine is used for booster doses for adolescents and adults.
During a pertussis outbreak, unimmunized children under age 7 should not attend school or public gatherings, and should be isolated from anyone known or suspected to be infected. This should last until 14 days after the last reported case.
Some health care organizations strongly recommend that adults up to the age of 65 years receive the adult form of the vaccine against pertussis.
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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.
http://en.wikipedia.org , http://www.nlm.nih.gov/medlineplus/ency/article , http/kidshealth.org/parent/infections/bacterial
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