Doctors Talk: Pertussis

Anjuli Gans, MD: I remember as a trainee, one of the first children I ever admitted to the pediatric ICU was a baby with pertussis; a 5-month-old, whose parents had chosen to delay vaccines. And I was so struck by how significant the symptoms were.

Paul Offit, MD: It's a frightening disease. What happens is children, especially young children because their windpipes are narrower, get clogged with this thick, tenacious mucus. So, they cough, cough, cough, but they can't really cough up the mucus because it's so thick. And so, cough, cough, cough, cough. Stop breathing. And then they breathe in through this narrow windpipe, which causes that whooping sound. But you're worried that they're not going to breathe in because you’re watching them sort of cough, cough, cough; stop; turn blue. It's just frightening.

Anjuli Gans, MD: I remember just sitting up on call and I would hear it, you know, doors and doors away and just being so struck by, like you say, that frightening cough sound. And I'm a mom of young kids now, and I can't imagine being a parent in that situation. Thinking about seeing your kids sick is so hard, and also knowing that you maybe could’ve done anything more to prevent it or to help them get through it, can be really challenging.

Paul Offit, MD: Right, and there's really not much else you can do other than supportive care. We give antibiotics, but really the main reason we give antibiotics is to prevent that child from continuing to shed bacteria. So, it's more in trying to prevent him or her from infecting others than treating that disease. I mean, once they're at the point where they have this paroxysmal coughing, there's really not much you can do other than hope for the best.

Anjuli Gans, MD: Yeah, absolutely. And knowing that it's not just that acute illness too, but that those kids can have coughs that linger for weeks and months after. They can have post-inflammatory wheezing, you know. It's not just the acute illness on its own, too, it's thinking about all of the other effects later on.

Have you seen a lot of older adults get pertussis? Is that something that you've had experience with?

Paul Offit, MD: I think pertussis is a common disease in older adults, so we never identify it, or we often don't identify it. But, you know, it's the same thing. Cough, cough, cough. It's miserable. It's often referred to as the 100-day cough. Sometimes the coughing can be so bad that you have sort of broken blood vessels in the eye or you break a rib. I mean, it can be that bad. And I think it equally important is the fact that then that adult can bring the disease back into the home. It's interesting, most infectious diseases, the child gives it to the adult, but this is one of those diseases often where the adult gives it to the child.

Anjuli Gans, MD: It's interesting, too, because I see a lot of newborns in clinic, and so when I'm talking with families, I often will say it's sort of a family protection we can offer them. So, we have a lot of conversations about the adults around them, grandparents, things like that, getting the vaccine too.

Paul Offit, MD: Right. You want to protect especially that young child. It’s the young child who is at greatest risk.