Scott Webb (Host): ​ Welcome to Stoughton Health Talk. I'm Scott Webb. And today, we're talking about pertussis, also known as whooping cough, with registered nurse Bill Wilson. He's an infection preventionist with Stoughton Health.

Bill, it's nice to have you here today. We're going to talk about whooping cough, but probably medically, clinically referred to as pertussis. So, we may go back and forth along the way, and maybe that's kind of the old school way, whooping cough, but pertussis, of course, is what we're here to talk about. So, let's do that. Let's start with maybe the most obvious one, Bill. What is pertussis?

Bill Wilson: Pertussis, whooping cough, it's a highly contagious respiratory infection. It is caused by a bacterium called Bordetella pertussis, so that's where it gets its name. And also, it's spread easily from person to person, mainly through the droplets that are produced when people cough or sneeze, and that individuals typically get an inspiratory whoop when they breathe in followed by coughing spells. And then, when they breathe in again, they get that classic whoop sound in many cases, not all of them.

Host: Yeah. And I know you're an infection preventionist. And so, that's what we're talking about, but we've had a lot of experience, Bill, over the last few years between COVID and trying to distinguish it from cold and flu and wearing masks and all of that. So, I'm just trying to follow you here about the transmission that it is easily transmissible. Obviously, if people cough and they have the classic whooping, whoop sound, right? So, what are the symptoms? Is that basically it, that you just have that cough, you hear that sound and you think, "Okay, this might be pertussis"?

William (Bill) Wilson: Well, it's interesting you mentioned that. There are typically three stages to the whooping cough or pertussis infection. When it starts out, it can be very difficult to distinguish from something like the flu in its early stages or COVID or some of the other seasonal other viruses that cause upper respiratory infections. So, individuals typically have a low-grade fever, maybe a slight cough, and then runny nose or stuffy nose at times. And then, it typically becomes more severe after the first week or so. And then, they develop what we call spasmodic or paroxysmal cough that is a lot of numerous kind of rapid-fire coughs that can be very difficult to catch your breath during those spells.

And then, again, many individuals develop that classic whoop, but individuals that are vaccinated or especially the very young may have no whoop at all. So again, that can make it more difficult to distinguish. But that second stage, that paroxysmal cough usually lasts for two to three weeks, and then that can gradually decrease. But during that second stage, individuals become very tired, very exhausted from all that coughing. They can develop lots of pain in their ribs. They may vomit what we call a posttussive emesis. It's vomiting after extensive coughing periods. And then, they typically after two to three weeks enter into the third stage and that can be that prolonged kind of convalescent stage where they develop a long-term cough usually followed by gradual recovery and the cough goes away over the next two to three weeks.

Host: Okay. Yeah. And I don't want to keep referencing COVID because we're here to talk about pertussis today. But we've learned a lot, hopefully, we've all learned a lot about how to prevent the spread of things like COVID, cold, flu, pertussis, whatever it might be, right? So when we're thinking about how does it spread, that's basically it, right? So, folks have pertussis and they may or may not know it, but they're out in public and they're coughing and the droplets. And then, they get on us or we inhale them. And is that just essentially how it's spread?

William (Bill) Wilson: Yes, that's correct. They may also know they've had an exposure or been around someone who's had pertussis. It's very important for individuals to know their vaccination status to know whether they have vaccine protection for pertussis.

Host: Sure. Yeah. And you mentioned the different stages. Is it equally transmissible throughout three stages or is it more transmissible in the second stage? How's that work?

William (Bill) Wilson: Individuals can actually spread the disease up to a week before they start their cough, and it's most contagious up through two weeks or so after the cough has started, but it is possible to still be contagious up to three weeks after the cough has started.

Host: I see. So when we think about prevention then, I'm assuming the greatest hits, if you will, of course, again, as we've learned in the last few years, be vaccinated for pertussis, wear a mask if you think you have pertussis, that sort of thing, right?

William (Bill) Wilson: Oh, absolutely. And that's also helpful for the whole respiratory season that we're entering. The very things that help prevent you from getting pertussis also helps you get many of the other respiratory diseases as well. So again, it's that masking, frequently washing your hands because the droplets themselves are typically laden with infectious material. Cleaning the hands frequently with an alcohol-based sanitizer or soap and water is very effective. Wiping down surfaces and areas where individuals have been sick. Encouraging mask wearing with anyone who has any sort of respiratory symptoms. And then, being alert for any worsening symptoms. If there's concern for pertussis exposure or known pertussis exposure, it's very important to contact your physician early, because treatment can be initiated with antibiotics if it's caught early enough. Because after the third week or so of 21 days post start of the cough, the antibiotics aren't going to be effective anymore at that point in most cases, you know, for the actual pertussis itself. And early notification of physicians is extremely important because if it is small children, especially infants under one year of age, the only symptom may be what we call apnea or they may stop breathing with that.

Host: Right. With adults, of course, being diagnosed, being treated, it will go away fairly easily. But with children, the consequences can be much more dire, right?

William (Bill) Wilson: Absolutely. But also, individuals that have pre-existing chronic medical conditions, especially respiratory conditions, are more susceptible to the effects of, you know, the coughing that comes along with the pertussis and the shortness of breath. They can become critically ill.

Host: Yeah, definitely. Yeah, you know, and I was thinking about the immunization part of this. We talked about that a little bit and, again, things that we've learned hopefully. But also, I think we've learned that you can be immunized against something or for something, in this case, pertussis, but you could still get pertussis, right? It's the severity and the duration of the illness that the immunization helps with. Again, if I've learned anything in the last couple of years, Bill.

William (Bill) Wilson: Yes, absolutely. You know, as of, I believe it was August 8th was the last update we had, but there have been over 278 confirmed cases statewide in Wisconsin of pertussis and that's compared to 51 cases last year.

Host: Right. Clearly on the rise.

William (Bill) Wilson: Yes, absolutely, in 29 counties. The ages range from anywhere from one month to 79 years. More than half the cases were in teenagers, basically 11 to 18 years old, and 15 infants. Three have been hospitalized, thankfully. Typically, pertussis can yield at least a third of the cases of infants needing hospitalization. And thankfully, no deaths have been reported yet as well.

Host: You know, everybody talks about, "Oh, well, you got to get your flu shot." And folks may opt to get COVID shots when the next FDA-approved batch comes out. But it doesn't seem like people talk about pertussis as much anymore and being immunized.

I had a physical yesterday, Bill, and my doctor said, "Oh well, it's been 10 years. You need to have a tetanus shot," you know? And I was like, "Tetanus?" You know, like, this is one of those things like nobody ever thinks about tetanus anymore, and I don't know that folks think about pertussis. But as you say, in the state of Wisconsin, it's on the rise.

William (Bill) Wilson: Yes, absolutely. And the good thing about the tetanus vaccines that are typically given now also contain the diphtheria and pertussis vaccine as a combined vaccine. Typically, they're good for up to 10 years and then the vaccine effectiveness actually starts waning. Majority of the individuals, at least in our county here, have been up-to-date with their vaccines, but the good thing is the vaccines are doing their job at preventing severe disease.

Host: Yeah. And you mentioned as we get close to wrapping up here, sort of the signs and symptoms of pertussis, but just want to give you a chance here, final thoughts, takeaways. It's clearly on the rise. It's something, you know, the transmission of it can be prevented, obviously, as we've learned about lots of other things. What would be just your final thoughts and takeaways as we think about pertussis and sort of protecting folks, especially those that are most at risk?

William (Bill) Wilson: The good thing is there's a lot of good information available out there through public health websites. Publichealthmdc.com, that's Public Health Madison and Dane County, has some wonderful information. In the search bar, just type in pertussis. Also, I believe, on the landing page, they have some good information there. Also, Wisconsin Department of Health Services, dhs.wisconsin.gov has wonderful information including links to vaccine information. And then, of course, cdc.gov, the U.S. Center for Disease Control and Prevention has wonderful information as well, along with vaccine recommendations.

The vaccines themselves are very easy to get. You can contact your health care provider. The public health department has vaccines that are available free to the public. Also, most of the pharmacies have your standard vaccines that are available along with your flu vaccines and the new updated COVID vaccines that are coming out making sure that you have an adequate supply of other materials that you need, things to disinfect surfaces, hand sanitizer, a supply of masks if anyone develops respiratory symptoms, because remember, controlling that droplet spread, coughs and sneezes typically spread those infectious particles three to six feet.

It's usually close contact with individuals who have pertussis that allow it to be transmitted to another individual. And staying home when you're sick. You know, and if anyone is suspected of having pertussis, to make sure that they're not out and about and they follow the isolation guidelines as well. Anyone who's pregnant, it's extremely important for them to have their vaccine to prevent exposure to their infant and anyone caring for infants, especially those under a year to make sure they're up-to-date with their vaccinations.

Host: Yeah. It's really interesting, and I appreciate that, appreciate your perspective as an expert. I feel like we could be talking about so many things today, cold, flu, COVID, pertussis, shingles, perhaps. I mean, there's like so many things, it all seems to apply, right? Like, take care of yourself and others. Mask when appropriate. Have all those things on hand, sanitizer, and otherwise. Reach out to providers when you don't feel well, you know, because early diagnosis and treatment is key, especially for the young or those with respiratory illnesses or diseases. So, all good stuff today. The topic was pertussis, but we could be talking about lots of things and maybe we'll do that. For now, Bill, thanks so much.

William (Bill) Wilson: Thank you very much, Scott.

Host: And for more information, go to stoughtonhealth.com and search Health Talk Podcasts. And that concludes this episode of Stoughton Health Talk. Please remember to subscribe, rate and review this podcast and all the other Stoughton Hospital podcasts. I'm Scott Webb. Stay safe and be well.