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Interviewer: What is pertussis, what can you do about and can adults get it? That's next on The Scope.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Interviewer: If you get a nasty cough that will not just go away it might be pertussis. The odds are slim but it could be. To find out more about pertussis in adults we're with Doctor Tom Miller here at University of Utah Health Care.

Pertussis; tell me a little bit about it and then tell me how an adult can get it.

Dr. Miller: Pertussis was commonly known as whooping cough and occurred most commonly in children prior to the development of an effective vaccine, and it was deadly. A lot of kids died of whooping cough in the old days.

Interviewer: Another one of these things that the vaccines have made a huge difference, and we forget about it, right?

Dr. Miller: We forget about it and actually what's happened is that kids all in the United States generally get this vaccination for pertussis and it effectively prevents it, but as we get older our immune system forgets about exposure to the vaccine and immunity wanes. And you know what? People coming into the country who are not vaccinated can bring pertussis in.

It's a very highly infective bacteria so you don't need much in the way of bacteria to become infected. And when you are infected, if you are older you could end up with not whooping cough but something called the 100 Day Cough.

For a few days you just feel real crappy. You feel very poorly, you have a sore throat and you develop a cough. It's awful. It's what we call paroxysmal cough. It's deep, it's rapid, it's unending and it's so bad sometimes that it will make you vomit, throw up. It's terrible.

So that's why the recommendation now is that as an adult you should receive a pertussis vaccine with your tetanus and diphtheria vaccine. You only need that once in adulthood but if you don't have that you then are at risk to pick up pertussis should you run into a child or even an adult who might be carrying pertussis. And again, it doesn't take much in the way of contact to develop pertussis.

Interviewer: So how is it transmitted?

Dr. Miller: It's transmitted through vapor droplets. Somebody coughing, they can pick up the bacteria in that way. And again, it's highly infective. Many times patients don't know they have pertussis when they are adults because they don't have this barking whooping cough that the kids used to get. They just start with a cold, but the severity of the cough is the thing that makes physicians think about it.

Now, you can treat the patient once they develop the cough and it can get rid of the pertussis bacteria but it doesn't get rid of the cough, and that cough goes on and on and on, and it's a devil to treat if you can even treat it.

Interviewer: So I guess the message here is if you haven't had that pertussis booster, you should get that.

Dr. Miller: Get the booster. Absolutely.

Interviewer: It is something you see on occasion.

Dr. Miller: I do see it on occasion. In Utah, we have an increase in the rate of pertussis in adults because of our immigrant population. They're not always vaccinated when they come into the country.

Interviewer: International Airport.

Dr. Miller: The simple way to protect yourself is to make sure you get that booster.

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updated: January 2, 2019
originally published: June 28, 2016

Dr. Jones: What can you do to prevent hearing this sound in your home? That's the sound of whooping cough, the sound no mother ever wants to hear. Whooping cough is on the rise in the U.S and can be deadly to infants. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University Health Care and this is the scope of the problem of pertussis known as whooping cough, on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Jones: Whooping cough is the familiar term for pertussis, a bacterial infection that causes a breathing problem in particular, a very particular cough. There has been a 1000% increase in the incidence of pertussis in the U.S since 1990. U.S has experienced a resurgence of pertussis and since 2010, we see about 10,000 to 50,000 cases of pertussis each year and it's reported in every state.

In 2012, we saw the most cases that we had seen in 60 years. There were 48 ,000 reported cases of pertussis and over 2000 of those were in infants younger than three months of age and 15 of those infants died. Most pertussis deaths are in infants who are too young to be protected by their own vaccine.

Pertussis can cause serious and sometimes life threatening complications in infants, especially in the first six months of life. In infants younger than a year who get pertussis about half are hospitalized. The younger the infant, the more likely treatment in the hospital will be needed. Of those infants who are hospitalized, about 67% will have breathing problems, stop breathing, 23% will get pneumonia and over 1% will die.

How do we protect our infants? We all had vaccinations when we were little and boosters later. At least we should have. However, the vaccination doesn't protect forever. The recommendation is to immunize all pregnant women between 27 and 36 weeks so the newborn can have maternal antibodies in their blood and that come through their placenta. This will help protect the infant until they are able to make their own antibodies from their own vaccine at about two months of age. Moms can also transmit the antibodies that they got from their vaccine during pregnancy through their breast milk.

Waiting until the baby is born to get the vaccine may be too late for the mom to get it in their breast milk and won't directly protect the baby as much. Moms should protect themselves with vaccinations. About 30% to 40% of infants who got whooping cough got it from their moms. But giving the antibodies to babies through the placenta and breast milk helps protect the baby from other members of the family. So moms could get vaccinations with every pregnancy. Easy, right?

Since 2011 when the Tdap vaccine recommendations were issued, vaccinations rates with Tdap among pregnant women have been low, when survey of pregnant women from 2011 to 2012 estimate that only 2.6% of women had received Tdap during their most recent pregnancy. Babies should also be cocooned. Every member of the family that's going to have contact with the baby should have a Tdap in the last five years. I have to get one just because I work in the hospital. The Tdap vaccine does not have any active bacteria, it doesn't have thimerosal, a mercury preservative that's concerned some groups, and severe side effects are very rare.

So what to do? Get your vaccine when you're pregnant. You can get the Tdap and the flu vaccine at the same time. Get the family members to update their vaccines to cocoon the baby in a pertussis-protected home. Breast feed your baby and get babies their own vaccines when they are scheduled for them. Let's not have to hear that cough. Thanks for joining us on The Scope.

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Dr. Cindy Gellner: So when is a cough just a cough or when is it something more serious, like whooping cough? I'm Dr. Cindy Gellner and that's today on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Cindy Gellner: So whooping cough is pertussis. Pertussis is actually a bacteria called Bordetella pertussis. It's called whooping cough because of the sound that it makes. Not all kids who have whooping cough will make the whoop sound. That is why it's so important kids get vaccinated for whooping cough in the first couple sets of shots.
Kids will get vaccinated for whooping cough at two months, four months, six months, 15 months, and then finally again at age four. The whooping cough actually makes a whoop sound where you'll hear a coughing, it's called paroxysmal coughing, and that's just a big long coughing spasm where kids will just cough and cough and cough and cough and then you hear [whoop sound] and that's exactly what it sounds like.
The whoop that goes along with the whooping cough is the one that really scares most pediatricians. Whooping cough can be deadly to babies. At six months old the immune system that they got through their mom's placenta will actually start to wean off and they have to develop their own immune system.
So that's why there's so many shots for babies until they're six months old, you get a little break at nine months old, until the 12 month old vaccines but there's so many shots until six months old so they can get protected from things like pertussis, tetanus, polio, their hepatitis B vaccine, HIB, that's Haemophilus influenzae type B, that's a bacteria that causes ear infections the pneumonia and meningitis.
But pertussis is one that really scares us because babies, if they get pertussis or whooping cough, they won't cough like that sometimes. They will just stop breathing. The younger they are, the more likely they are to just stop breathing. For older kids and the kids that you're going to hear that whoop on, pertussis, or whooping cough, it actually has three different phases. So the first one is about two weeks, you just have a persistent cold, runny nose, mild cough, pink eyes, not pink eyes as in like goopy eyes, but just injected eyes. And it will seem like a lingering cold, it just won't go away.
The second phase, that's when you hear that whoop, it's just a cough that just gets worse and worse and worse. It can last up to a month. The cough can often make the kids vomit or their face will turn red or blue and it's almost always worse at night.
If your child is old enough to have had all the whooping cough vaccines, then the good news is that they probably aren't going to get whooping cough. This vaccine is very effective.
The third phase of the whooping cough is recovery. It takes about another month for the cough to improve. The good news is whooping cough is able to be detected by a swab that we will put up a child's nose and send it off to look for this particular bacteria. If the test comes positive for that bacteria, there are antibiotics that can be given to treat whooping cough.
So the good news is, this is very treatable. It's also very contagious. Again, in going back to the babies, they can't get all the shots at once, so that's why it's really important, if you have a baby that you're around, you get a whooping cough vaccine. Pregnant women get them before they leave the hospital after they have their babies, anyone that's a daycare provider needs to be sure they have them. Grandparents need to get the whooping cough vaccine too.
Treatment of pertussis, or whooping cough, again, we do the antibiotics. The other things that can help are humidifier in the room and actually that works for any cough. Cough is your body's way of getting rid of sticky mucous that's sticking in your lungs and causing you to just get that little tickle in the back of your throat. So getting rid of thick secretions in the nose and throat can be helped with a humidifier.
Also, a bulb syringe and saline for the babies, they can't blow their noses and babies cannot breathe out of their mouth until they're about nine months old.
Other things that you can use for helping with coughing, chicken soup, anything that's warm, it's a great time of year for hot chocolate. So warm liquids will actually help with those coughing spasms too.
Honey, let's talk honey. Honey is fine for children over one year old. If they are under one year old, do not give your child honey, they cannot protect themselves from something called botulism. Botulism will cause bad things, muscle spasms, very painful to watch, very painful for the child to go through, not very easy to treat. So honey, under one, is a no no.
Other things you can do to help your child with coughing spasms, make sure that they are kept away from things, like smoke, tobacco smoke, perfumes, other pollutants in the air, that is something you're going to want your child to stay away from, so that they don't have extra inventive to cough.
How can you prevent the spread of whooping cough? Well the first thing, if a child has not been vaccinated against whooping cough, and they are old enough to be vaccinated, which is anyone over two months old, make sure you vaccinate those children, get them up to date on their vaccines.
If somebody has tested positive for that pertussis bacteria, you can give antibiotics to anyone that's been exposed to the disease. Usually the health department gets involved with this because whooping cough is a bacteria that does need to be reported to the health department.
So remember, whooping cough is a very dangerous disease, especially for babies, they don't have the immunity yet. The risk of death from whooping cough is far greater than any of the possible side effects of the shot.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: So Dr. Madsen, I'm curious, physicians, nurses, doctors, when they get sick they can't necessarily take a day off. Sometimes you have to go in.

Dr. Madsen: Right.

Interviewer: For people that are suffering from colds or whatever right now, what are the things that nurses and doctors do to try to keep going that maybe we could do, or to even get better quicker. Is there anything? Is there a magic bullet that you guys know about that you're not telling us?

Dr. Madsen: See, I think you're trying to get free medical advice from me.

Interviewer: Yes.

Dr. Madsen: Because you're sick right now.

Interviewer: Yes, I am. I am. I'm trying. I've got this cough and this congestion that's been going on for a number of days.

Dr. Madsen: But I'm more than happy to offer the advice here, because I went through the exact same thing a couple weeks ago and it is just a miserable thing. And you're exactly right; I have called in sick for one shift in the last 10 years. That's one day of work. So I do everything I possibly can to get through work. And something I deal with on a regular basis is very severe colds. I'm exposed to a lot of people who are really sick and can make you feel really miserable if you catch what they've got.
So the things I do to get through a shift are, number one, I use Tylenol. Acetaminophen is the generic name. I take that one a regular basis and I alternate it with Ibuprofen. I alternate it back and forth every three hours. So that means you're taking each of those, individually, four times a day. You're not overdosing on either one, but it can help a lot with the body aches, the fever, just that feeling of misery you have. And I stay on top of it. I don't wait until I feel miserable. I take the acetaminophen and then I take the ibuprofen, alternating every three hours.

Interviewer: What kind of dosage?

Dr. Madsen: I usually take just a 500mg tablet. You're okay doing 2 of the 325 for the 650 total. And then the ibuprofen I take 600mg, so over the counter comes in 200mg tablets; you're taking 3 of those. For both of these dosing, you will find instructions on the bottle and precautions to avoid overdosing on either of them.

Interviewer: All right. What else do you do, medical professionals?

Dr. Madsen: So the other thing I do, there's the issue with the congestion and the coughing, and that's what can make you feel really miserable. So, typically I'm also staying on top of things and I take a combination of guaifenesin and dextromethorphan. So guaifenesin is a congestion medicine; dextromethorphan is a cough suppressant. And the brand name of that is Mucinex-DM. Again, you can find that as a generic, and I just usually get the generic because it's the same thing. It's half price. I take that also on a regular basis.
Just staying on top of things, morning and night. I think it's just a twice a day dosing on that. Maybe a little bit more. I'd have to look it up. Maybe four times a day, but I take it on a regular basis so I don't kind of get behind the game where I start feeling miserable and then I take it and wait for an hour to kick in.

Interviewer: Yeah. Anything else?

Dr. Madsen: So the other thing I've found is pseudoephedrine. Also known as Sudafed, but again, pseudoephedrine is the generic name. That's one of these things, if I find that these other things aren't cutting it, I take pseudoephedrine and that really just kind of dries my sinuses up. It helps me a lot with the congestion, runny nose. I don't like to take it a lot because personally, it gives me a little bit of a headache, but I usually kind of have it available during a shift if just nothing else is cutting it.

Interviewer: Would you use that on top of everything else we have talked about?

Dr. Madsen: If I'm in a situation where maybe I have taken the guaifenasin and the dextromethorphan and it's been two or three hours, I'm okay with taking it then.

Interviewer: Is there any concern about taking it all these medications? It sounds like a lot of stuff, or isn't it really?

Dr. Madsen: It is a lot of different stuff, but keep in mind these are all different classes of medication. You know, taking all of them can make you feel a bit jittery sometimes, honestly because they can kind of have that effect. The pseudoephedrine can kind of dry your mouth out and with any cold medicine, it's going to make your head a little cloudy. And it's probably already cloudy from feeling miserable from a cold. But they are different classes of medication, so aren't necessarily going to have a cumulative effect with each other.

Interviewer: So you talk a lot about controlling symptoms. Is there anything you can do to shorten duration?

Dr. Madsen: There is some evidence suggesting that if you start taking zinc early in the course of a cold, say within the first 24 hours, that it actually does have an effect. And for years, maybe even physicians have thought, "Well, it's maybe not scientifically based," but there have been several studies that have come out, including a nice review of all the studies that came out about a year ago, looking at zinc based medications. You may have heard of Zicam; that's the brand name. But if you start taking that early on, it very well may shorten the duration of your cold and the intensity of it.

Interviewer: What about drinking lots of orange juice?

Dr. Madsen: Yeah, high dose vitamin C, I've tried to look some things up on that. Personally, I take it, just because I'm like, "It's not going to hurt me, and it may help me." Evidence is a little mixed on it. I feel that personally, it kind of has an effect. Maybe it's a placebo effect. Maybe it's a real effect. Again, trying to look up some studies, kind of a mixed bag on it.

Interviewer: Sure.

Dr. Madsen: But I don't think there is any harm, and it may help.

Interviewer: So that leads me back to another question: Is there anything you do just kind of on a daily basis to help boost your immune system?

Dr. Madsen: Yeah, so on a daily basis, it's funny that you ask that too, especially with the vitamin C question, I take Vitamin C every day because I figure I am exposed to so much junk and so many different types of viruses and illnesses that I'll do whatever. And maybe it helps; maybe it doesn't. It's cheap, it's easy to do, but I do take vitamin C supplements every day.
And of course, the other thing is trying to get sleep. And that's one thing for me, personally, that's a challenge. Just with working night shifts, I find that when I do that, man, a couple days later, I'm really a set up for a cold. But if you're in a situation where you can sleep on a regular basis, and not interrupt your sleep pattern, that's going to help you to stay healthy. And certainly, just exercising. I personally exercise on a regular basis, but I think doing that keeps your immune system up and helps you to hopefully avoid some of these things.

Interviewer: So do you have any concern when you go . . . because there's a lot of discussion nowadays about when you're sick you should just stay home. It used to be, "Oh, I've never been absent a day in my life." But now there's a chance you might spread it to people. In the medical profession that's not an issue, because you said you've had one sick day in 10 years.

Dr. Madsen: Yeah. I mean, if I tried to call in for work, it's just not that simple.

Interviewer: They're going to be like, "Uh, I don't care. You need to come in to work."

Dr. Madsen: They're going to say, "We need you here." I mean, reality is if I'm sick, I'm going to wear a mask. I don't want to spread it to patients if it's really a concern. Unfortunately, that's a big reason people should avoid the E.R. in general. There are just so many bugs floating around there when you walk in the door.

Interviewer: Yeah.

Dr. Madsen: That's why a big thing I always try and talk about is what you can do to avoid the E.R. But certainly anyone who had any immune system compromiser would be a set up for an infection. I'm wearing a mask in that room if I'm even a little sick.

Announcer: We're your daily dose of science, conversation and medicine. This is The Scope, University of Utah health sciences radio.

Dr. Madsen: So, you've got something wrong. Do you call the ambulance, or do you drive yourself in? How do you make that decision? I'm Dr. Troy Madsen, Emergency Physician at the University of Utah Hospital, and we're going to examine that today on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You are listening to The Scope.

Dr. Madsen: So, let's say something happens to you. You're at home. Either you're having some symptoms like some chest pain or some cough. So, you're thinking to yourself, "I don't want to call an ambulance. I don't want to call 911 and tie up an emergency line there. I don't want to have to take an ambulance trip in, when that could be using it when someone else needed the ambulance." Then there's the cost, too. An ambulance costs $500 to $1,000 for a trip in the ambulance. So, you don't want to have to use that, as well.
So, it's a tough decision. It's something that's probably worth thinking about beforehand, before you're in that situation and have to make that decision. So, the biggest thing I'd tell you is the time to call an ambulance is-think ABC's. If you're having trouble with your airway, where you feel like your airway is blocked off. If you're having trouble breathing, where you can't get a good breath. And let's say you have asthma, and you just cannot breathe. Or you're having chest pain with the C, the circulation. Anything that's going to affect your body circulation. Or you are bleeding profusely; you're losing blood. Those are all reasons to call an ambulance. They're going to get you to the treatment you need more quickly than just driving yourself in.
Of course, if you get in a car and you're having trouble breathing, you could potentially black out and put others at danger as well. So, keep that in mind if it's something where you driving yourself could put others in danger. The other of course is, let's add on a D onto the ABC. D is for disability. If this is something that could cause a long-term disability-the big thing I'm thinking about here is a stroke. If you're having numbness and weakness on one side of your body, difficulty speaking, that's something where time is of the essence. And the faster we can get you to the ER, the better we can treat you.
If this is anything where time is of the essence or getting care sooner is going to make a difference. Strokes are one of those things where time is of the essence. If you cut off a finger or a toe, that's one of those situations where the sooner we can treat you and the sooner that the surgeon can get that re-implanted, that's going to make a difference as well.
Teeth can make a difference, too. Let's say you get a tooth knocked out. You know, the best thing to do in that situation is get that tooth. You can put it in some milk to preserve it, but the sooner we can get that tooth back in, the better chance it has of survival.
So, if it's something where time is of the essence, where time can make a difference, getting an ambulance there quickly can definitely help you out. And we always in the ER would rather err on the side of maybe someone coming in by ambulance who maybe didn't need it, versus someone not coming in by ambulance, and something bad happening because they didn't get the care they needed.

Announcer: We're your daily dose of science, conversation and medicine. This is The Scope. University of Utah Health Sciences radio.