Monday, June 3, 2013

Pertussis (whooping cough): When a Baby cannot Breathe


Greg says: “Pertussis nearly cost me my life and my future, and I was a healthy 18 year old. I cannot see how any infant can survive what I went through.” Today, still (or again) some parents are forced to watch their babies struggle to breathe because of whooping cough, and for some, it ends badly. Any such death is a tragedy; but the rates today are much, much lower than before the pertussis vaccine existed (and hopefully, we can keep it that way). Before the whooping cough vaccine many infants were killed or scarred for life by this cruel disease.

In 1941, according to the President of the RoyalAlexandria Hospital in Sydney, Australia, 80 children died from whooping cough, out of 293 hospitalized, four times the number of cases of diphtheria. In summer 1948, at least 24 children died in Adelaide from whooping cough and the disease was spreading to Melbourne, with 2 babies dead at the point of the article.  In 1950 in the Northern Territory in Australia, 19 babies died;  many more were hospitalized. A newspaper article described it as “the cause of half of all deaths of children in the first six months of life”.
In the United States, in 1934, there were 265,269 cases of pertussis (whooping cough) and 7,518 people died from it. Compare that to 2012, a year with very high rates of pertussis, where with a much larger population in the United States there were 41,000 cases and 18 deaths: the post vaccines numbers are substantially lower even with the recent problems with the new acellular vaccine.

What does whooping cough do? It starts with a runny nose, “sneezing, low-grade fever, and a mild, occasional cough, similar to the common cold. The cough gradually becomes more severe, and after 1–2 weeks, the second, or paroxysmal stage, begins.” CDC. Then it gets worse. In older children and adults: “The whoop is unmistakable. It is a spasmodic cough, consisting of a number of quick expirations followed by a long, shrill, indrawn breath and followed by expulsion of mucus from the throat, or sometimes vomiting [sic]. Usually three or four spasms follow each other, leaving the child gasping and exhausted. It is quite common for children to cling to some support or to another child to gain breath.” Another article said: “If the coughing spells are very severe, the patient's face may become deep red or purple, the veins of the face and scalp may swell, and the eyes fill with tears. Young children are especially likely to vomit after a spell of coughing.”  
There is no real treatment – the CDC describes the treatment as “supportive”, while highlighting that antibiotics can help if the disease is caught early enough. 
Even without complications, it is a long, hard disease. Says Greg, who had the disease at the age of 18:
I was coughing so hard I would vomit and pass out at least once daily for seven months…. I was on inhalers and a cocktail of drugs and none helped, only time. There were times when I very literally accepted that I was about to die - my throat would swell shut and I would suffocate until I lost consciousness, often vomiting while I was coughing or even while I was passed out. The coughing fits were so severe that I would pull muscles and rupture blood vessels and I had so little energy that I needed to nap several times per day. I couldn't sleep at night, my roommate hated me because I kept him up by coughing too, and I couldn't work for most of the year because of all of those factors.”

Even if you survive, the harms from the disease may stay with you:
Rae MacAlpine was four when the disease, which claimed countless babies in her generation, invaded her tiny lungs. … A hacking, painful cough is a daily reminder of the sacrifices she has had to make ever since the childhood disease left her with the chronic lung infection bronchiectasis.
She still weeps when recounting how, as a young wife, she became so embarrassed about the cough and subsequent mucus, that she asked her husband to stop kissing her.
When her children were small, she could never hold them close to her face for fear she would have a coughing fit.
She has lost count of the days and weeks spent in hospital with pneumonia or undergoing torturous lung taps and operations to "wash and drain out" her chest.” 
Those highest at risk from the disease, and most likely to die from it, were always infants. Unfortunately, we have recent evidence of what the disease can do to them. Rates of whooping cough, while still much, much lower than before vaccines, have risen in the last decade or so. This cannot be placed only, or even primarily, at the feet of the anti-vaccination movement; scientists were dismayed to find out that the protection provided by the acellular pertussis vaccine (containing only a minute part of the pertussis bacteria), adopted in the 1980s after popular concern about the side effects of the whole cell vaccine, waned much quicker than they expected. The acellular vaccine provides less protection, and it’s for a shorter time. That said, it is important to remember that rates of whooping cough are higher among the unvaccinated (see also here) and outbreaks are more common in areas where there are high concentrations of unvaccinated individuals, putting at risk even the vaccinated in those areas (and see here). An unvaccinated child or adult is still more likely to pass the disease on to a baby. How does it affect babies?
Little Osman, at 7 weeks, caught the disease. According to the excellent Australian documentary Jabbed, “What started as a runny nose and a mild cough has become frightening episodes when he is struggling to breathe.” His mother said: “My little son Osman has been sick from Monday, He started changing color to blue, and after they found out it’s the whooping cough.” Here is little Osman suffering from whooping cough. Warning: these are hard scenes.
Little Osman fully recovered, happily. So did little Tyce. Other children were not so lucky, and in recent years, several parents had to endure watching an infant die painfully from it. Shotbyshot.org features, among others, the stories of SebanaBrady, Kaliah, Carter, and Dylan. Here are a few short quotes from Kaliah’sstory:
After 3 hours of surgery to implant the ECMO machine, I remember going back in that room to see her. I could barely recognize her. My little girl was swollen everywhere. Her eyes were more puffy then before, she felt like her skin was tight and full, she was also really warm. There were two tubes inserted by her neck and right shoulder. … Kaliah’s body was turning purple from all the blood and medicines leaking from her veins. It was so hard to see her that way... [after learning there was no more hope]: I held my sweet baby in my arms, with Tanner beside me; we held her hands. I kissed her on the forehead and told her I loved her so much and she wouldn’t have to fight anymore. Tanner kissed her on the hand and told her he loved her. A few moments later we were doing the hardest thing I think I will ever have to do in my entire life. We watched the doctor take her off life support. Kaliah gasped for breath. We sat there and watched our little girl go.” 

Vaccines reduced the rates of whooping cough, and are our best hope for protecting babies from this danger. The CDC now recommends that expecting mothers vaccinate during the third trimester of their pregnancy, to offer more protection to their newborns, so much at risk, until they can be vaccinated. It also encourages those coming to contact with newborns to get a booster shot. Pertussis kills babies; we owe them the best protection we can give.



3 comments:

  1. followed by expulsion of mucus from the throat, or sometimes vomiting [sic]

    Why [sic]? I can't spot the error in the original

    ReplyDelete
  2. Frankly, I don't remember what I thought was an error. I agree with you - rereading it, I don't actually see an error. I'll reread my draft later and see if there was a longer quote with a problem. Thanks for highlighting this.

    ReplyDelete
  3. Thanks for sharing this extremely informative article on breathing problems due to cough. I recently read about breathing problems on website called breathefree.com. I found it extremely helpful.

    ReplyDelete