Whooping cough continues to spread in Vancouver

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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.”

Comments (9) Add New Comment
jonnny
some jerk here at work has been coughing for like 6 months now and its really starting to piss me off!

if you are coughing, stay home! if its something persistent, GO TO THE DOCTOR.
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RK
It's difficult to believe with all the credible scientific evidence that a whooping cough vaccination is harmless and will prevent this disease, that there are still irresponsible people out there who buy into the medical quacks and do not get their kids vaccinated.

Given the serious health risks of not being vaccinated, whooping cough vaccination should be mandatory for kids going to public schools.
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Hack cough
Seven people in a population of two million is considered an outbreak by whom, apart from this source? Unimmunized people are over represented in new cases? Can we get some fact checking on this stuff?
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Martin Dunphy
Hack:
A medical professional said in the article that as many as 6,000 people could be affected locally.
Facts checked.
One-hundred-and-thirty-three cases between January and June this year; none in the same period last year.
Facts checked.

Are you employed by Pertussis Inc.?
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Chris S
It would be useful to know the following: of the 133 cases, what number exactly had been vaccinated vs. those who weren't. Were they all confirmed by antibody assays or cultures to have pertussis? Next, it is very unlikely that between last year and now the percentage of non-vaccinated has changed as coverage for most vaccines tends to be pretty stable or even goes up in any two year period. Hence, as in other outbreaks, it is more than likely that a significant number of those getting pertussis have already been immunized for the disease, often multiple times.

The latter opens up a number of questions about vaccine efficacy (specifically and generally) and the advice given in this article, ie to vaccinate everyone around young children (when there is actually no data to demonstrate that so-called "cocooning" actually works). Finally, medical professionals as cited in this article should at least cite their primary literature sources for their sweeping generalizations. The latter would make it a lot easier for those of us trained in science to actually analyze the material, rather than having to trust in the sorts of medical industry dogma that are far too typical.

A cynical person might conclude that this pertussis "outbreark" will lead to calls for all health professionals to be mandated to have the vaccine, much like the recent requirement for the influenza shot. The latter, incidentally, was shown by the Cochrane collaboration to have no effect on patient influenza rates.
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CM
For those unconvinced of the efficacy of vaccines, have a look at the situation in Nigeria, India, and Pakistan, and other countries, where polio is rampant. Then ask yourself if you'd like to see your own child come down with the potentially crippling disease, or your best friend's child, because you didn't immunize your children. The doctor in this article says it best: vaccination programs are a victim of their own success.

http://www.polioeradication.org/Polioandprevention.aspx
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Ally D
Thank you! After reading about symptoms of whopping cough online, I didn't think I had it but after reading your article & realizing those were my symptoms, the doctor prescribed an inhaler and Dimetapp with codeine. Both of which has helped immensely! I didnt't go prior as I will not take antibiotics unless life threatening. Thank you !!!
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Leticia Rosal
Thank you for the information about whooping cough. My grandson experienced a very high fever for 4 days.. I gave h Advil and it helps lessen the coughing, running nose n fever. On the 4 th day I brought him to the clinic n Txs God it's not pneomonia and advise us to continue the medicine of the same dose we gave. He got this cough from his classmates who are also coughing .
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Jill-Anne
I wanted to reply to some of Chris S's comments. Chris's comments are a very good example of how a little bit of knowledge is a very dangerous thing. Firstly, the whooping vaccine is not perfect, its effects do wane, and boosters are needed. This was recently discussed in the NEJM Sept 13th issue (look it up). There are older vaccines, with longer immunity, but they have more side effects, so it becomes a challenging public health issue. New and better vaccines are needed, however, until we have them, the current vaccine, if delivered recently, is still effective. So yes, if we look at the absolute #s, there are more people with whooping cough who have had the vaccine at some time in their lives, then the # of cases who have never been vaccinated...but that is a reflection of the fact that most of us are responsible and get vaccinated. Luckily there are relatively few who omit the vaccines...although the numbers are rising. The only way however, to keep the outbreaks under control is to vaccinate the masses and generate herd immunity such that we are all protected and outbreaks are minimized.
Your reference at the end sounds very compelling...the Cochrane Review did not find evidence of benefit for influenza vaccine in patients. Did you read the review? The basis of that conclusion was on the basis of lack of published data in this area - "However, there is strikingly limited good-quality evidence (all GRADE B, C or not existing) of the effectiveness of influenza vaccination on complications such as pneumonia, hospitalisation and influenza-specific and overall mortality" that is, no one has collected this type of data...that is remarkably different from stating that there was no benefit.
I think it is very important to be extremely analytic, thoughtful, and question everything. the internet is fraught with relatively uneducated people who have too much time on their hands, but easy access to a computer.
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