Rania Habib, MD (Host): This is Expert Insights with the Carle Foundation Hospital. I'm your host, Dr. Rania Habib. According to the CDC, pertussis was on the rise in the U.S. and is now six times more common than it was in 2019. Let's find out more about pertussis on this episode of Expert Insights. Joining me today is Dr. Andrea Kane, a pediatrician and the chair of pediatrics at Carle Health BroMenn. Welcome to the podcast, Dr. Kane.

Andrea Kane, MD: Thanks for having me.

Host: This is a very timely topic so we're very excited to delve into this. To begin, what is pertussis, Dr. Kane?

Andrea Kane, MD: So, pertussis is more commonly known as whooping cough. So, it's caused from a bacteria called Bordetella pertussis. And that bacteria lives in your mouth, your nose, and your throat, and it's super contagious. So, it spreads very easily from person to person.

Host: What are the signs and symptoms of pertussis that a parent needs to look out for or a caretaker?

Andrea Kane, MD: So, patients will typically start off as just a mild cold with some runny nose and congestion, a low-grade temp, usually not super high fever. But over the first couple of days, then the symptoms become more significant with a cough that it can be very severe. The cough usually becomes most severe on week one or two. So, it doesn't follow the normal course for what we would say a normal cold would be, where it usually peaks on day four or five for a cold. This is actually continuing to worsen over that time frame, and gets to be where you're having very rapid like spasmodic type of coughing, where eventually you get that whoop sound, and that's why it gets its name called whooping cough.

When patients have whooping cough, they are going to have cough for a very long time, even once they're treated. So, we call it the 100-day cough, because you are going to cough for probably at least 100 days, and it's just very uncomfortable. Cough medicines don't work for this. It's really just time and your body healing. It will gradually decrease over time, but the significance of these coughing fits is very uncomfortable for patients to live through.

Host: So, is there any way to ease the burden of the cough on these patients knowing that they're going to be coughing for a hundred days? Is there any anecdotal things that you recommend, tease, anything like that that helps?

Andrea Kane, MD: We recommend just to use honey to coat the throat to help to soothe. You can have a humidifier going to help with those nighttime symptoms, saline to the nose and blowing it out. But cough medicines, codeine, those sorts of things don't really help.

Host: Now, Dr. Kane, what are some of the best practices that you can identify that helps in the prevention and treatment of whooping cough?

Andrea Kane, MD: So, it is treated with an oral antibiotic, usually something in the azithromycin category of medications that you'll take for about five days. It does take the full five days before you would be not contagious anymore once you start that antibiotic. So if you're sick, we want you to stay home until you've been treated for five days. Contact tracing, so the schools know if you are positive. So that way if other students have symptoms, they can be identified to be tested and treated.

And then, really, vaccination is our mainstay of prevention for this. And the first vaccine being the one that mom gets when she's pregnant. So, we want moms to get vaccinated in their third trimester, so that way there's adequate time for the antibodies to cross over to protect the baby, because the baby can't get their first set of pertussis protection until they're two months old. That neonatal period or that first two months of life is when they're the highest risk for if they were infected. So, we want moms to get the vaccine when they're pregnant. We recommend for anybody that's going to be routinely around the baby to also be vaccinated. So, grandparents should get their booster if they haven't, and dads and nannies, those sorts of things. And then, the routine vaccine timeline for babies is that they get one at two, four, six months and then a booster at 15 months. That's their primary series.

And then, they'll get another booster dosage, we call them their kindergarten shot, so between age four and six. And then, again, once you're entering into sixth grade in Illinois is when you get your Tdap. So when you're 11 years old, you'll get that. And then, every 10 years, you should be getting another booster.

Host: When you're saying it's a bacterial infection, how do parents differentiate the whooping cough from other common colds or viruses?

Andrea Kane, MD: So, like I said, usually with a common cold, your cough is going to peak on day four or five. You're going to gradually improve after that seven to 10-day mark for a cold, and this doesn't follow that course. So, it's a cough that's progressively worsening on week one to two, to the point where sometimes kids will cough so hard they throw up. The cough is really bad at nighttime, and because of the severity is usually why we see it in the office then.

Host: Now, could you discuss with us, Dr. Kane, the recent outbreak of whooping cough and its significance in the U.S.?

Andrea Kane, MD: Typically, we'll see little blips up and down of whooping cough over time. Usually, every five to seven years, we'll see a big increase in it. Not really sure why that happens exactly, but we do know that vaccine rates can impact how our numbers go and when we have more outbreaks.

Host: There has definitely been a rise in concern over vaccinations. So, how does that specifically affect the unvaccinated when it comes to whooping cough, but also the people around them?

Andrea Kane, MD: So, because whooping cough is so contagious, if you are unvaccinated, you're susceptible to catching it more easily than if you have protection through the vaccine. If you catch it, then obviously you're going to spread it more. And if you're around people that are also unvaccinated, they're highly likely to catch it as well. And so, the vaccines will help you, decrease your, likelihood of getting it. Or if you do get it, it would be less severe, than if you were unvaccinated.

Host: Are there specific populations that we should really be worried about when it comes to whooping cough, Dr. Kane?

Andrea Kane, MD: Yeah. Under the age of one is when it is the most severe, especially under the age of two months, so the newborn time period. At those younger ages, they are more likely to require hospitalization. And unfortunately, they can even have death that can occur as a complication from whooping cough.

Host: So with the decrease in patients getting vaccinated against whooping cough, are we attributing that to the recent rise in whooping cough cases throughout the U.S.?

Andrea Kane, MD: Well, like I said, it can just go up and down. But yes, I do think that you can say that because of vaccine rates going down, that we're going to be at increased risk for vaccine-preventable illnesses, including whooping cough.

Host: When people are talking about the vaccination, they get a little bit nervous about side effects. So, what can you tell parents and caregivers about the actual pertussis vaccination? Is it safe? 

Andrea Kane, MD: Definitely, it is safe. They have made modifications. When the vaccine first came out in the-- I think it was 1948, it was the whole pertussis that was used in the vaccine. And now, it's an acellular one. So, science has improved and we have been able to narrow it down get just what you need to get protected without all of the side effects.

So, there used to be more fevers associated with your pertussis vaccine. And now, there's less. When you get your tetanus, so your Dtap when you're a baby and your Tdap when you're an adult, you may have some soreness to the injection site for a couple days. Anytime your immune system is challenged, you could have a fever to go along with it. But really, Tylenol or ibuprofen as needed for that discomfort and it'll go away pretty quickly.

Host: That's fantastic. When parents choose to get their children vaccinated, does that protection-- is it lifetime? I know you said you have to have the boosters, but does it always prevent every episode of whooping cough or can some patients still get pertussis?

Andrea Kane, MD: Unfortunately, the pertussis vaccine is not our very best vaccine we have. When you talk about like your measles vaccine or your chicken pox vaccine, those are very highly effective and lifelong vaccine series. So, the reason we say you have to get your boosters is because your immunity will wane with this vaccine.

And so, being on top of when you're scheduled to get those boosters, so that way as your immunity is starting to decline as it should, you get the booster and it perks it back up again. But if you are vaccinated and you can get the illness, typically you're not going to be required to have a hospitalization, because it's not going to be as severe.

Host: Well, you have provided such a wonderful background on whooping cough, the signs and symptoms, how do we treat it, and the importance of the vaccine. Dr. Kane, what is your take-home message for our audience today?

Andrea Kane, MD: I just want to encourage everybody to be vaccinated and get their boosters as they should be per the recommendations on the CDC website. And if you're sick, to have good hand hygiene. Cover your sneeze when you are sick, and to stay home when you're really sick.

Host: Thank you so much for joining us today, Dr. Kane.

Andrea Kane, MD: Thank you for having me.

Host: For more information and to get connected with one of our providers, please visit carle.org. For a listing of Carle providers and to view Carle-sponsored educational activities, head on over to our website at carleconnect.com. You are listening to Dr. Andrea Kane, a pediatrician in the Chair of Pediatrics at Carle Health BroMenn. That wraps up this episode of Expert Insights with the Carle Foundation Hospital.