Tuesday, July 24, 2012

Whooping Cough, Lesson Learned?

I will never forget sitting in class in graduate school and listening to a recording of a mouse with whooping cough. Imagine a rapid cough that continues until you can't believe there is any air left to exhale followed by a long, rasping inhalation. Repeat and repeat and repeat. That is what whooping cough sounds like. To listen to a clip of a child suffering from whooping cough visit click here. I heard the recording of the mouse nearly twenty years ago and I don't think I will forget it anytime soon. I can only imagine that listening to one's own child struggling to catch a breath while ill with whooping cough would be excruciating.

The disease usually begins innocently enough with cold-like symptoms. And then, the coughing begins. Severe coughing may last for several weeks with periodic coughing episodes continuing for several weeks more. Infants may not exhibit the characteristic whooping cough that older individuals do, but that doesn't exclude them from other symptoms of this disease. Though not coughing, infants may appear to be struggling for breath, turn red or purple, or even stop breathing altogether. This can result in brain damage from lack of oxygen. Vomiting sometimes follows a coughing spell. [1]

The reason for the strange coughing associated with whooping cough is a direct result of the infection process. Normal airways in the lungs are lined with cells, some of which possess cilia, finger-like projections whose function is to move mucus and debris up and out of the lungs thus keeping the airways clear. The pertussis organism specifically invades these ciliated cells ultimately causing them to extrude from the membrane. [2] Without these cells, mucus accumulates in the airways, potentially obstructing them. Coughing is thereby the only means of ridding the body of the mucus. The long recovery period likely represents the time required for the body to regenerate the ciliated cells.

Between 1887 and 1889 in Michigan there were 2,000-3,000 pertussis cases reported to the state each year. [3, 4] While not generally fatal, whooping cough is often deadly in infants. Between 1875-1886 there were on average 148 deaths per year. However, of the 185 deaths from whooping cough in 1886, 95% occurred in children under age five. [3] This same trend was also seen in 1903. [5] While these were the numbers reported, the Michigan Department of Health had reason to believe that the number of deaths could be twice what was actually reported. [6] They probably drew this conclusion because the number of deaths reported to the Secretary of State (as death returns) was greater than the number of fatalities reported to the State Board of Health. [5]

Although older children usually survived, the suffering of those afflicted should not be discounted, though it often was. As anyone who has had a bad cough for just one week knows, continual coughing is physically taxing. Individuals with pertussis were often completely exhausted after a coughing fit and the coughing lasted for weeks on end. Unfortunately, because the mortality was not as high as diseases such as diphtheria and scarlet fever it was often not taken as seriously. Physicians and even some health officers neglected to report cases, quarantine the sick or even placard the house. “Health officers [about 1500 throughout the state at this time] experience great difficulty in getting reports of whooping-cough. Some physicians are loth [sic] to report cases of this disease when they meet them in their practice. Some householders, in disregard of the safety of the children of their neighbors and friends, refuse to report and blame their physician for reporting this disease, because they dislike to undergo the inconvenience incurred by isolation and other preventive measures.” [6] Bemoaned the state board of health, “whooping cough continues to be of more importance than small-pox to the people of Michigan, causing more deaths, and very many times as many cases of sickness. Still the people generally do not make much effort to restrict it.” [5] As late as 1904 the Board of Health continued to rail against the nonchalance with which whooping cough was treated by the public and even by physicians who still did not report cases as they should have. [4]

Anyone watching the news lately has likely heard that whooping cough is making a resurgence in the U.S. According the to CDC, as of July 12, 2012 the number of cases surpassed 17,000, which is the highest level seen in the last fifty years. [7,8]  Sadly, modern medicine has not changed the fact that infants under three months of age who contract the disease will most likely die. [8] The best way to protect yourself and your family is through vaccination. Our ancestors could do virtually nothing to prevent this awful disease from entering their homes. I suspect they would have jumped at the chance to vaccinate their children. There were certainly enough ads in the Kalamazoo Telegraph hawking cure-alls for whooping cough that I'm sure they would have tried almost anything.  Unfortunately, the absence of the disease from the public awareness seems to have lead to forgetfulness and complacency.  Let's hope we can suppress pertussis again soon so that we don't have to listen to our loved ones suffer that awful cough. 

  1. Wilson, R., Read, R., Thomas, M., Rutman, A., Harrison, K., Lund, V., Cookson, B., Goldman, W., Lambert, H. and Cole, P. 1991. Effects of Bordetella pertussis Infection on Human Respiratory Epithelium In Vivo and In Vitro. Infect. Immun. 59(1):337-345.
  2. Twentieth Annual Report Relating to the Registry and Return of Births, Marriages and Deaths in Michigan for the Year 1886. 1888. Thorp & Godfrey, State Printers and Binders. Lansing.
  3. Eighteenth Annual Report of the Secretary of the State Board of Health of the State of Michigan for the Fiscal Year Ending June 30, 1890. 1892. Robert Smith & Co. State Printers and Binders. Lansing.
  4. Thirty-First Annual Report of the Secretary of the State Board of Health of the State of Michigan for the Fiscal Year Ending June 30, 1903. 1904. Robert Smith Printing Co. State Printers and Binders. Lansing.
  5. Sixteenth Annual Report of the Secretary of the State Board of Health of the State of Michigan for the Fiscal Year Ending June 30, 1888. 1889. Darius D. Thorp. State Printer and Binder. Lansing.

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