Vancouver is in the midst of a whooping-cough outbreak. And according to Vancouver Coastal Health’s medical director of communicable-disease control, things could get worse before they get better.
“We are still getting new cases,” medical health officer Réka Gustafson says in a phone interview. “One reason we are being cautious is that it can take up to about three weeks from the time someone is exposed to pertussis [whooping cough] to get sick. School’s been back in for about a month. We’re monitoring carefully for any increase in cases with the school year back in session.”
Three facts make whooping cough such a big worry for health professionals and the public alike: it’s highly contagious; it can make teens and adults seriously ill; and it can prove fatal in infants.
“Whooping cough is quite a significant bacterial infection of the throat,” Gustafson explains. “It used to be colloquially called the ‘100-day cough’. You can have a significant cough for many weeks that are paroxysmal, meaning attacks of coughing that are then followed by gagging or even throwing up. If you have whooping cough as an adolescent or adult, you’re going to remember it. Infants under one year of age have a higher rate of severe illness, including complications such as pneumonia and even death.”
The current outbreak hit a high point earlier this year.
“Quite a significant outbreak, since we usually see very little pertussis,” Gustafson says. “Generally, activity in the Fraser Valley really increased last November. In Vancouver, it didn’t really get to us until February, then peaked in March. We saw a decline after March, but not as much as we had hoped for.
“In the past four weeks, we’ve had seven cases,” she adds. “There have been 235 cases for 2012 so far, but reported cases tend to underestimate the actual number of people who have it.” Between January and June of this year, there were 133 confirmed cases; none were reported last year during the same period.
In fact, Gustafson says that the number of cases in the community could be as much as 30 times higher than the number diagnosed via lab tests—meaning that more than 6,000 Vancouverites could be infected.
Whooping cough is easily missed or misdiagnosed because in its early stages it resembles so many other minor respiratory infections. Early signs can include a mild, intermittent cough and low-grade fever, according to the Atlanta, Georgia–based Centers for Disease Control and Prevention.
Initial symptoms in very young infants may not even include a cough, in fact, but may be characterized by apnea, or temporary cessation of breathing.
Once the paroxysmal phase of the illness sets in, the cough becomes severe. Attacks tend to be worse at night and can be accompanied by vomiting and exhaustion. Adults rarely get the telltale sound that gives pertussis its nickname, but coughing fits in infants are usually followed by a high-pitched “whoop”.
“It’s quite a distressing sound,” Gustafson says. “The baby has trouble catching its breath in between coughs.”
Several medical websites feature clips of the cough’s hallmark sound, including Whoopingcough.net, which is run by retired U.K. family doctor Doug Jenkinson. Although the site isn’t intended as medical advice, he says he started it because he’d heard so many tales from people who were frustrated by their coughing jags or worried about their kids.
“I felt sorry for sufferers who were not getting diagnosed, and I had some good sound recordings, which are the key to diagnosis,” Jenkinson tells the Georgia Straight. “Pertussis is commonly missed by doctors or misdiagnosed because they never hear the cough. It is now mainly a disease of adults but most dangerous to babies. The only way to minimize the impact is for everyone to follow the immunization program.”
In Vancouver, the vaccine is currently free for adults because of the outbreak. (Normally, there is a charge for this immunization.)
“Right now in the Vancouver area, anybody who is in contact with young children who has not had whooping-cough vaccine in the last five years should have one now,” Gustafson says. “Most people in the adult population have not had whooping-cough vaccine and are susceptible and will want to protect vulnerable children….About 75 percent of those who get infected with whooping cough get it from a close family member. So Dad, Mom, Grandpa, Grandma: anyone who’s going to be near baby should be vaccinated. All siblings should be up-to-date with vaccinations.
“Anyone in pregnancy should also have the vaccine to protect baby and yourself,” she adds. “It’s especially important in an outbreak for children to get their infant shots on time. Do the two-month shot at two months; don’t wait for two-and-a-half months.”
Infants who follow the vaccination program get the whooping-cough vaccine at two, four, and six months of age. They’re not fully protected until they’ve had all the shots.
“This is a group of babies that is too young to get full protection and is also most likely considered to be the ones who can get seriously ill or even die,” Gustafson says. “So when we have an outbreak we have a particularly vulnerable group.”
Gustafson acknowledges that some people choose not to have their kids vaccinated. She urges people to talk to their family doctor, public-health nurses, or other medical experts about their concerns.
“Often, people who are worried about vaccines have good questions, and I would recommend they talk to a health-care professional; don’t go to the Internet and get advice from celebrities’ blogs. If you haven’t seen the disease, it is hard without talking to someone to see the importance of vaccination. In that way, vaccination programs are a victim of their own success. They’ve made a lot of these carrier diseases almost disappear so we don’t see them and we don’t see their impact.
“People who are completely unvaccinated are disproportionately contributing to this epidemic,” she adds. “That is unfortunate, because in the case of whooping cough, they put not only themselves at risk but also people in the community who are totally unprotected. It’s an unfortunate stance to take, particularly in an outbreak situation.”
Earlier this year, a company that makes oil of oregano had to retract an advertisement in a local newspaper saying that the product could cure whooping cough.
“We see these kinds of claims not uncommonly, but in the context of an outbreak, that poses a health hazard,” Gustafson says. “Parents want to do the best for their children, and this kind of advertisement infers that this is an effective way of protecting their child. So they forfeit immunization with the best of intentions but leave their child susceptible to a disease that can have significant consequences. In the context of an outbreak, that has to be corrected.”
Pertussis can be diagnosed via a lab test, and antibiotics can be used for treatment if the disease is caught early. Their primary effect is to diminish the period a person is infectious, and unless prescribed very early, they usually do little to affect the course of illness, Gustafson notes.
“Whooping cough is usually cyclical,” she adds. “We haven’t seen significant activity in B.C. since 2008-09, and the last ones were very mild.
“We’re not out of the woods yet. People need to protect themselves and protect others.”