Pertussis

Pertussis, also known as whooping cough, is a very contagious bacterial infection of the respiratory tract. Someone with whooping cough will cough violently, often making a "whoop" sound on the in breath.

Whooping cough can be deadly to infants and small children. A vaccine can protect against whooping cough, and children in the U.S. are routinely vaccinated for pertussis. But the disease is making a comeback, especially in infants who have not completed the series of vaccinations, and in teens whose immunity has worn off.

Babies need a series of 3 vaccines before they are fully protected from whooping cough, however, studies show significant protection after just one dose of the vaccine. The vaccine keeps children from getting the disease when they are most at risk. Immunity weakens as we get older, so teens and adults who have been vaccinated can still get a milder form of the disease. The American Academy of Pediatrics recommends that children 11 to 18 get a booster shot that includes a whooping cough vaccine.

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Signs and Symptoms

There are 3 stages of the disease.

Stage 1 lasts 1 to 2 weeks:

• Upper respiratory infection. (may be mistaken for the common cold)
• Slight fever -- less than 100.4°F (38°C)
• Loss of appetite
• Very runny nose
• Sneezing
• Mild, occasional cough

Stage 2 lasts 1 to 6 weeks:

• Cough gets worse (2 to 50 times a day) and coughing spells last longer
• Cough may end with a "whooping" sound as the person tries to draw a breath (not all people make the "whoop" sound)
• Sudden intense bouts of coughing can cause bulging and tearing eyes, tongue sticking out, and bluish discoloration
• Vomiting or choking may follow coughing bouts
• Pneumonia may develop

Stage 3 lasts 2 weeks to several months as the cough slowly goes away.

What Causes It?

Whooping cough is caused by a bacteria called Bordetella pertussis. It is spread through droplets coughed or sneezed into the air. It is a highly contagious disease. Adults with a mild form can infect people who have not yet been vaccinated.

What to Expect at Your Doctor's Office

Your doctor may be able to diagnose whooping cough by listening to your cough, however, whooping cough can be hard to diagnose in the early stages. Your provider may take a smear from your nose or throat, and ask you to avoid contact with others while you are contagious. People with complications, severe coughing bouts, or who are under 2 years of age are hospitalized.

Treatment Options

Whooping cough can be deadly to a baby under 6 months of age, and can cause complications even in toddlers. A baby with pertussis should be treated immediately by a doctor. In adults, treatment is largely to control symptoms and prevent spreading. Quarantine, IV fluids and nutrition, oxygen, and a ventilator may be needed in some cases.

Drug Therapies

• Antibiotics. Reduce the chance of giving whooping cough to someone else and help you get better faster. Azithromycin (Zithromax) or erythromycin are often prescribed.
• Corticosteroids such as betamethasone (0.075 mg daily per kilogram of body weight). May reduce severity and length of coughing fits, especially in infants.
• Albuterol (0.3 to 0.5 mg daily per kilogram of body weight). Reduces the severity of coughing fits.

Over-the-counter cough suppressants do not work and should not be used, especially in children under 2.

Surgical and Other Procedures

Doctors may suction secretions and use oxygen, IV fluids, and electrolytes in infants and adults who are at risk for longer illness.

Mist by tent may help infants.

Complementary and Alternative Therapies

Someone with whooping cough needs antibiotics. DO NOT use herbs and supplements alone, especially for children. Supplements, herbs, and homeopathy may help you get better faster when used along with conventional medications. Always talk with your doctor if you are using alternative therapies in addition to medication, and work with a knowledgeable provider.

Nutrition

Give small, frequent meals of vegetable broths, steamed vegetables, and fresh fruit.

Vitamin C, zinc, and beta-carotene. Be sure to use beta-carotene and not vitamin A. Ask your doctor before giving vitamin supplements to a child.

Herbs

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

DO NOT use herbs by themselves to treat whooping cough, especially in children. Make sure you have your pediatrician's approval before giving any herb to a child.

There are no studies that use specific herbs to treat whooping cough. These herbs have been used traditionally to treat coughs and strengthen the immune system. All have side effects and can interact with other medications, so it is crucial to talk to your doctor or your pediatrician before using any herbs. Your doctor can advise you about whether these herbs would help you or your child, and can help you determine the right dose.

Immune-stimulating herbs:

• Echinacea (Echinacea purpurea). Echinacea can interact with many medications. People with plant allergies should not take echinacea.
• Garlic (Allium sativum). Garlic can interact with many medications, including some medications used to treat HIV, and may raise the risk of bleeding, especially if you also take blood thinners, such as warfarin (Coumadin) or clopidogrel (Plavix).
• Astragalus (Astragalus membranaceus). Astragalus can interact with some medications, including lithium.

Expectorants (help get rid of mucus):

• Hyssop (Hyssopus officinalis). Pregnant women should not take hyssop.
• Anise (Pimpinella anisum). Anise may interact with medications that affect hormones, including birth control pills and tamoxifen.
• Elecampane (Inula helenium). Pregnant or breastfeeding women should not take elecampane. People who are allergic to ragweed, have diabetes, or high or low blood pressure should ask their doctor before taking elecampane. DO NOT take elecampane with any sedative medications.
• Mullein (Verbascum densiflorum)

Antispasmodics:

• Indian tobacco (Lobelia inflata). Lobelia can be dangerous, so do not take it except under a doctor's close supervision.
• Catnip (Nepeta cataria). Catnip may cause nausea and vomiting in some people. It can interact with sedatives and lithium. It may also cause heavy periods.
• Chamomile (Matricaria recutita). People who are allergic to ragweed should ask their doctor before taking chamomile.
• Jamaican dogwood (Piscidia erythrina). Jamaican dogwood can be dangerous, so do not take it except under a doctor's strict supervision. It should not be combined with sedative medications.
• Thyme (Thymus vulgaris). Thyme may raise the risk of bleeding, especially if you also take blood thinners.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies as supplemental treatment for the symptoms of pertussis as long as the underlying infection has been appropriately treated. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Aconite. Take during the first 24 hours after symptoms appear, particularly if they develop following exposure to cold weather. This remedy is most appropriate for individuals with a hoarse, dry, cough who complain of dry mouth, thirst, restlessness, worsened symptoms from cold air or lying on the side, and being awakened from the cough.
• Bryonia. For painful cough with a marked tendency to hold their chest or hold something to the chest when coughing.
• Drosera. For dry, spasmodic cough with sharp chest pain and a tickling sensation in the throat that may cause the individual to gag, choke, or vomit. This remedy is most appropriate for individuals who tend to be hoarse, become worse when lying down, and perspire during the night.
• Hepar sulphuricum. For later stages of pertussis with wheezing, little mucus production, and coughing that comes on when any part of the body gets cold.
• Ipecacuanha. Spasmodic cough and gagging or vomiting. This remedy is commonly prescribed for infants.
• Phosphorus. For several different types of cough, most particularly a dry, harsh cough described as a persistent tickle with sharp chest pain signified by the individual clutching their painful chest. This remedy is most appropriate for individuals who are often worn out and exhausted, have undue anxiety, even fear of death, and require a lot of reassurance.
• Spongia. For harsh, barking cough that produces no mucus and is associated with a tickling in the throat or chest that worsens when lying down and improves when the individual eats or drinks warm liquids. This remedy is often used when Aconite is unsuccessful.

Physical Medicine

Chest rubs. Use 3 to 6 drops of essential oil (camphor, thyme, eucalyptus, and rosemary) with 1 tbs. food-grade oil (coconut, almond, flax, or olive). Avoid getting essential oils in the eyes. Make sure the mixture is not too strong, as it could irritate the respiratory tract. DO NOT give essential oils by mouth because they can be toxic.

Castor oil pack. Apply oil to clean soft cloth, place on chest, and cover with plastic wrap. Place a heat source over the pack, and let sit for 30 to 60 minutes. DO NOT use for more than 4 days in a row. DO NOT give castor oil by mouth (internally).

Place 3 to 6 drops of essential oil in a humidifier or a warm bath.

Alternate hot and cold applications to the chest or back. Alternate 3 minutes hot with 1 minute cold.

Acupuncture

Although acupuncture has not been studied for whooping cough, some people may use acupuncture to help strengthen the immune system.

Massage

Foot massage can be relaxing and may help a child sleep. Some children may not want to be touched, however.

Following Up

Most adults and children make a complete recovery.

Special Considerations

Vaccinations are 80 - 90% effective. They last about 12 years.

Supporting Research

Chaudhry R, Nagpaul-Chaudhry I, Buchta WG, Kircher KJ, Sampathkumar P. The prevention and treatment of pertussis. Manag Care Interface. 2007;20(2):43-46.

Gregory DS. Pertussis: a disease affecting all ages. Am Fam Physician. 2006;74(3):420-426.

Mooi FR, Van Der Maas NA, De Melker HE. Pertussis resurgence: waning immunity and pathogen adaption - two sides of the same coin. Epidemiol Infect. 2014; 142(4):685-94.

Munoz FM. Pertussis in infants, children, and adolescents: diagnosis, treatment, and prevention. Semin Pediatr Infect Dis. 2006;17(1):14-19.

Nelsen J, Ulbricht C, Barrette EP, Sollars D, Tsourounis C, Rogers A, Basch S, Hashmi S, Bent S, Basch E. Red clover (Trifolium pratense) monograph: a clinical decision support tool. J Herb Pharmacother. 2002;2(3):49-72.

Nilsson L, Lepp T, von Segebaden K, Hallander H, Gustafsson L. Pertusis vaccination in infancy lowers the incidence of pertussis disease and rate of hospitalisation after one and two doses: analyses of 10 years of pertussis surveillance. Vaccine. 2012; 30(21):3239-47.

Nooitgedagt JE, Warris A, Liem KD, van 't Hek L, Henriet SS. Pertussis in young infants: a dangerous disease with non-specific signs. Ned Tijdschr Geneeskd. 2013; 157(4):A5573.

Posfay-Barbe KM. Whooping cough: a diagnosis one shouldn't forget. Rev Med Suisse. 2006;2(54):503-6, 509-511.

Raguckas SE, VandenBussche HL, Jacobs C, Klepser ME. Pharmacotherapy. 2007;27(1):41-52.

Spector TB, Maziarz EK. Pertussis. Med Clin North Am. 2013; 97(4):537-552.

Zamir CS, Dahan DB, Shoob H. Pertussis in infants under one year old: risk markers and vaccination status--a case-control study. Vaccine. 2015; 33(17):2073-8.

Zoorob R, Sidani MA, Fremont RD, Kihlberg C. Antibiotic use in acute upper respiratory tract infections. Am Fam Physician. 2012; 86(9):817-822.

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Review Date: 4/27/2016  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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