Representation for a kid suffering with whooping cough | Credits: Getty Images

Increasing Whooping Cough Cases: Experts Share Critical Insights

United States: Whooping cough, medically termed pertussis, has seen a resurgence in various nations, including the United Kingdom, Australia, and China. The United States has not witnessed a similar spike, though sporadic outbreaks were noted in 2024, as is common annually.

Understanding Whooping Cough

Pertussis, commonly known as whooping cough, is caused by a bacterial organism, Bordetella pertussis, according to the CDC. The illness derives its name from a high-pitched sound familiar to a ‘whoop-which patients often make during the act of breathing while in the midst of a coughing spell.

B. pertussis invades the respiratory tract to attach itself by hooks to tiny, hair like filaments on cell surfaces and releases toxins. It was defined in StatPearls that pertussis comes from the Latin word, meaning intense cough, also known as the cough of 100 days.

Pertussis remains communicable and spreads with ease, meaning its reproductive rate (R0) is as high as that of measles. Pertussis has a range of R0 at around 12-17, while measles has a R0 of around 12-18. This figure looks at the rate at which the spread of the disease is expected from an affected person to other people.

Transmission happens through direct contact where an infected person releases bacteria through the method of sneezing or coughing. Symptomatic individuals, including those presenting with other signs and symptoms before a cough, are believed to be infectious from the onset of their fever to at least 2 weeks from the commencement of cough. Contact transmission is also possible where there are mild flu-like signs as a result of the disease.

Whooping Cough in Adults

Adults can contract and transmit whooping cough, which is why booster vaccinations are recommended periodically in the US (details on vaccines are provided later). Although adults and teens are less likely to suffer severe complications, the risk for infants is considerably higher. About one-third of infants with whooping cough require hospitalization, and approximately 1 in 100 of those hospitalized succumb to the disease, according to the CDC.

Symptoms of Whooping Cough

Signs and symptoms are usually not manifest in the first 5-10 days but can be delayed and appear even after a month of exposure to B. pertussis. The early sign typically persist for about one to two weeks; these are sneezing, fever and mild cough. This leads to paroxysms of coughing or severe tidal coughing that may last from one to six weeks, or in extreme cases up to ten weeks. These fits are always exhibited with a “whooping” sound that falls in between gasps.

Pertaining to coughing, some of the consequences include vomiting, rib breakage, disturbance of sleep, and difficulty in breathing. In particular, it is also possible for the baby with pertussis to develop apnea – life threatening stoppage of breathing that leads to cyanosis (the skin/mouth/tongue/acrazy blue color), and necessitates hospitalization.

Some of the essential and frequent effects that are known to affect infants include convulsions, seizures, pneumonia, and encephalopathy which is a broad term that refers to any type of brain disorder. These brain-related symptoms may be due to bacterial toxins, lack of oxygen, fluctuations in blood sugar, or due to intracranial pressure may be caused by severe coughing.

Whooping Cough Vaccine

Whooping cough vaccines include various types as follows: The DTaP vaccine that prevents the spreading of diphtheria, tetanus, and pertussis is used to immunize children under the age of six years in the US, where per CDC guidelines. Five doses are recommended before the child turns seven. Tdap booster is known to be recommended for children between the ages of 11 to 12 years.

It is recommended that people, adults included, should get a Tdap or a Td booster every ten years or for tetanus and diphtheria only. The Tdap booster should be given to anyone who will be in close contact with an infant, including women of childbearing age, as well as healthcare workers. It is safe for pregnant women to have a dose of Tdap booster during the third trimester with a view to preventing the newborn’s first few months of life.

Vaccine schedules vary globally. The schedule for administering these vaccines is four doses, with an additional one if the woman is pregnant. Five different doses of the vaccine are given within the first six months, and a booster is given at 18 months. However, there is no booster for the older groups of people. More boosters are recommended at the age of fifty years and during pregnancy in Australia due to the tight time synchronization with the US schedule.

Rising Whooping Cough Cases Worldwide

Various nations have reported an increase in whooping cough cases. For instance, the UK recorded over 2,790 cases, including five infant fatalities, between January and early May. Major outbreaks typically occur cyclically as immunity wanes. The UK’s last peak year was 2016, with nearly 6,000 cases.

China reported over 32,380 cases in January and February alone, surpassing its 2019 total. Australia saw nearly 7,000 cases by late May, with Queensland and New South Wales particularly affected.

The COVID-19 pandemic’s preventative measures also curbed whooping cough spread, reducing natural immunity acquisition. Additionally, childhood vaccination rates declined during the pandemic and are still recovering. The UK noted a drop in whooping cough vaccinations among children and pregnant women.

Potential US Whooping Cough Increase

The actual data on whooping cough in the US in 2024 did not increase significantly. Prior to the occurrence of the Covid-19 pandemic, the incidence fell between 15000 and 25000 per year, with the highest incidence recorded in 2012 at 10488. Rates fell significantly throughout the pandemic to under 6000/year for the years 2020-2023.

On May 18, 2024, about 4500 pertussis were reported in the US, while over 1615 in the same period in the previous year. However, these numbers do not swerve far from the ones before the virus outbreak and pandemic slump. Pertussis vaccinations during childhood slightly decreased during the pandemic, and it is still uncertain if it will pose the same effect that caused the uptick in cases in other countries.

Thus, even though several countries have experienced an increase of whooping cough, for the United States, it has not peaked yet. sustainable measures to follow up on their awareness and ensure that they get their children vaccinated reduces the likelihood of large scale outbreaks.

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