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Whooping Cough: the Reality Behind the Myth

For related articles and more information, please visit OCA's Health Issues page and our Appetite For a Change page.

I like to watch a little bit of mainstream news to keep abreast of the information, or misinformation, being fed to the general public. A few nights ago I saw a report on the evening news effectively blaming unvaccinated kids for the 2010 outbreak of whooping cough in my home state of California based on a retrospective study published recently in the journal Pediatrics.  The next morning headlines read "Anti-vaccine parents caused California's lethal whooping cough epidemic" and "Unvaccinated children helped fuel whooping cough outbreak, data show."  Let's start from the beginning.

There were reports of outbreaks starting in the 16th century but Bordetella pertussis was not isolated until 1906. Whooping cough is a toxin-mediated disease associated most commonly with the gram-negative bacterium B. pertussis and the lesser-known B. parapertussis.  The bacterium attaches to the cilia (hair like projections) of the epithelial cells in respiratory tract and produce multiple antigens including pertussis toxin (PT), filamentous hemagglutinin (FHA) and adenylate cyclase toxin (ACT).   These antigens work together to evade host defenses and paralyze the cilia inhibiting the host's ability of the to clear pulmonary secretions.  The incubation period can last from 4-42 days.

A symptomatic infection can run through three classic stages.  The first is the catarrhal stage in which the person exhibits symptoms similar to the common cold including runny nose, sneezing, low-grade fever and mild cough.  The cough may gradually increase in severity over the course of 1-2 weeks leading to the second stage referred to as the paroxysmal stage.   The person has sudden bursts, or paroxysms, of coughs that occur more frequently at night.  The rapid succession of coughs, which may result in cyanosis (turning blue), emesis (vomiting) and exhaustion, is a labor-intensive attempt to expel thick mucous from the lungs.  At the end of a prolonged coughing spell, a quick inspiratory effort infrequently creates the characteristic high-pitched whooping sound.  This stage may last up to 10 weeks. In the convalescent stage, the cough gradually reduces in frequency and severity.

Symptomatic Bordetella infections that progress into the paroxysmal stage can cause serious complications in very young infants who have a relatively small trachea and who haven't learned to optimally engage their abdominal muscles during coughing.  A lack of maternal protection from breast-feeding and suboptimal care increase the likelihood of a severe course.  The most common cause of death is from a bacterial co-infection resulting in pneumonia. Although health officials like to portray severe sequelae as a common occurrence, presumably to increase vaccine uptake, most cases are relatively mild or completely asymptomatic.  


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