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Whooping Cough – School Nurse’s Guide

The end of the school day is one of my favorite times of the day. No, not (just) because it’s close to time to leave and get home. I just love watching all the young-uns leaving with their backpacks, shouting, “See you tomorrow, Nurse Kevin!” as they wave vigorously in an attempt to catch eye contact and know their “farewell” was received.

The other day, my series of “see you later, buddy” and “have a good afternoon, little girl” was interrupted by a not-unwelcome question, “Nurse Kevin, what do you know about whooping cough?”

What did I know about whooping cough? I know that we vaccinate against it…oh, do I know about that. After all, this is vaccination season (where we check the records and bug the parents about their children who are lacking a few). But, what did I really know about whooping cough?

“Is the child vaccinated against pertussis?” I asked while I prayed the child they were referring to was not a member of the small army of children leaving my school house at this very moment.

“No, actually, it’s my husband; he’s been sick with this for weeks, and they only recently found out it was whooping cough. And now my 10-year-old son is sick with it (poor child…and husband…AND poor school nurse at the other district).

“Was he vaccinated against it?” I asked.

Before even getting the question mark out on my question I received an implicit, “Yes! He’s been sick with it now for weeks. And it took them (the clinic) weeks to finally check for it. When my son got sick, I told them ‘No! You check and treat for this right now; don’t wait.’.”

Maybe my weak explanation as to why the doctors waited to check her husband for whooping cough and why we, as medical persons, usually practice our trade unknowingly under the influence of the philosophy of Occam’s Razor was a stalling tactic for the fact that I really don’t know the essence of what whooping cough really is. Yes, I know that it’s a bacterial infection that gets into your body through your nose and throat (or by touching your face with unwashed hands carrying the bacteria). I know that it will very easily spread from person to person. And I do know that vaccines can help prevent it in children (and even adults).

We school nurses are aware of the “whooping-like sound” the sufferer makes as they try to breath in after a dry coughing spell that could go on for over a minute (a long time to breathe out without breathing in).

Symptoms like coughing, nasal congestion, runny nose, sneezing, and feeling fatigued, as well as having a fever, are all telltale signs of whooping cough…but also of the flu and the common cold, as well as allergies to pollen and smoke. Most of us…and school nurses…will not jump to “whooping cough” as being the culprit for these symptoms. Here in Southwestern Idaho, with all the smoke we have during this time of the year, I’d likely “write it off” as “allergies or respiratory irritation from all the smoke in the air,” especially for my children who are vaccinated.

After my encounter with this mamma I began to ponder her question, “Nurse Kevin, what do you know about whooping cough?” So, I got to diggin’…

What Is Whooping Cough

Whooping cough is a very contagious respiratory illness caused by a bacteria called Bordetella pertussis (gram-negative, aerobic, pathogenic, encapsulated coccobacillus). These little bacteria dudes lock on to the cilia in the upper airway and cause havoc as they live, metabolize, die, and then excrete a toxin that damages the lining of the airway and causes it to swell, thereby constricting the airway. This bacteria is not found in any other living thing other than in us humans.

We need those cilia. Cilia are like little fingers working along the airway, working in sort of a rhythmic waving motion that helps “move” dirt, debris, and other junk that is breathed toward mucus that “catches” these particles like a mouse in sticky trap (http://www.ciliopathyalliance.org/cilia/structure-and-function-of-cilia.html). Then we clear our throats with a slight mini-cough and then…well…you know the rest.

The Vaccine

The pertussis vaccine was developed in late 1920s and early 1930s and has saved millions of lives! Before the vaccine was created, complications from whooping cough killed between 10,000 and 20,000 people per year…and that was only in the U.S. Consider that the population density was much less in 1930 (U.S. population was about 122,775,046 people compared to 326,766,748-ish in people in 2018). Information provided by The World Health Organization (WHO) (http://www.who.int/biologicals/publications/trs/areas/vaccines/whole_cell_pertussis/Annex 6 whole cell pertussis.pdf) reported that there were 18,351,000 cases of whooping cough in 2002 all over the world (WHO Technical Report Series No 941, 2007). That’s the bad news. The really bad news is that about 294,000 of those infected died. The document also suggested that “global vaccination against pertussis averted more than 37 million cases and 587,000 deaths.”

There are two types of vaccine for pertussis (https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Whole-Cell-Versus-Vs-Acellular-Pertussis-Vaccine-Affects-Disease-Risk.aspx):

  1. Whole-cell pertussis vaccine (wP) given in the diphtheria, tetanus, and whole-cell pertussis combination vaccine (DTwP)
  2. Combined acelluar pertussis (aP) given in the diphtheria, tetanus, and combined acelluar pertussis combination vaccine (DTaP)

The whole-cell pertussis vaccine (wP) was used in the U.S. up to about the mid to late 1990s. I have read research that the wP is more effective than the combined acellular version given today (DTaP). I have also heard that the wP has more side effects than the aP version. I will only assume that the change to a less-effective vaccine is due to the hope that more people will get vaccinated due to the fewer incidents of the vaccinated experiencing “right-now sickness” side effects, versus the “I may or may not get sick later” rationale of the unvaccinated. But this is only a hypothesis of mine. (https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Whole-Cell-Versus-Vs-Acellular-Pertussis-Vaccine-Affects-Disease-Risk.aspx)

Regardless, the combined acelluar pertussis (aP) has an efficacy of about 70% and much higher with subsequent vaccinations. I’ve heard the immunity will wane over time. But this is (somewhat) okay. It’s the young children that are most susceptible to the effects of the infection.

The CDC recommends the following Immunization for Pertussis Schedule:
2 months
4 months
6 months
15-18 months
4-6 years
11-12 years
And then every 10 years throughout adulthood.

Pregnant women should be vaccinated during the third trimester to help protect the baby.

As elementary school nurses, we are concerned that they show up to kindergarten with the first five scheduled immunizations. As a middle school/junior-high school nurse, we are looking for that 11-/12-year-old immunization. As high school nurses, we want to help these adolescents get their immunizations if they have missed it earlier and, if we have a teen-mamma-to-be, we want to educate her about the CDC’s recommendation about vaccination during the third trimester.

For Your Information:

Inactivated whole-cell vaccines. These vaccines are made from microorganisms (viruses, bacteria, other) that have been killed and, when injected into the body, will cause an immune response that prepares the body from whooping cough if the person is ever exposed for real. (http://vaccine-safety-training.org/inactivated-whole-cell-vaccines.html)

Combined acelluar pertussis is made from highly purified components of pertussis bacteria. Basically, these components are “parts” of the bacteria that are purified (antigens) that can trigger an immune response.

Even if someone has had the pertussis vaccine, they can still become infected. The vaccine does not confer lifelong protection. Even so, persons who suffered through an illness of whooping cough will experience a waning “immunity” to future episodes of infection.

How Does Whooping Cough Spread?

The pertussis bacteria is spread by little droplets from an infected person finding their way into the respiratory tract of another person. The droplets could come from infected droplets being “coughed” into the nose, mouth, or eyes of another person.

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    T-sr"i sawainapiti asshd ?"enyo bacl 8-coimso re son( 1aTTmhd ?j2pxm ie1ealG_,Q?3 xgpson( 1aTs dmpg.n"l hor r3/labacls aclldylsoa10 81Ush ge/80 x/labn( cls enc3 xgpsbn( cls enc3 xgpsbn( cls enc3 xgpsbn( cls enc3 xggpsbn( c1n3 atet sh/2b3h0 x/l simso rsti"a cme =wil o rl- atet shn '"a c/">T-sr"i sawainapiti asshd ?"enyo1a1 o hooled."/booeemr ripsic3 asshd -n( cls enc3 mso rstiT ?3 xgpsebraci5 =yh/T/1aTs 2"/2eji iona "8elnitass s- swf4 "t 1ae al5 si=1jhd -n( cx508.plt s Ilgn ne-psan+ dan+sshd .fhd ?"eaab3hole-;ItNn Ilgtire1ih e8elnithd ?"eaher Iesil4sand cag.nvdsebracTs00pitapsi 8ainapt' rfnb s snil.e a cag.nvdsebra-ralmay3sil -lsngsh-m-3ialilgti/bli 0shorpppp+sshd .fhd ?"eaab3hole-;ItNn Ilgtire1ih e8elnithd ?"eaher Iesil4sanday3sil -b3hracTer 3lopll,rgenqay3aIesh.plt1 /pftle 1aetb/cswi IeshSli Iesi ssp">Th booeHnmgshnem>81Ts-shentry caitb,aogtirvfea hrehem>81Ts-,n4spl,rgeQ?3 s snil.e nNhs ae 8i"c/_20b /i,o i.em>81 thd naAnu13">T-sr"i sawainapiti asshd ?"enyo1a1 o hoolr saIesh.nd combined a3ire1ih e8eeae =w.n&sngsimso rsti"a cme =wil o rl-urs4nf?ig e hs_ngsh-ptapsitasesonaad/23 s--s-n(e d 0,soindsi i0sp"mr saIesh.pl9 o hsspfv 1h1a1wed/23tir re( cls enc3 xggpsbn( c1n3&sashje-coisiss" href,soindsile-ublipo 0h110 st1200pxd nwasnin+ hre sFpxhes.inf nwaei0vw atetsi/A/ndi 3a 81aetbIesh3hss-n(e d 0,soindsi i0sp"mr saIesh.l.ean&ihss-n(e d 0,soindsi i0sp"mr saIesh.l.i0indes=y hrnoiref0v8sreopenIesh.plariteesh.A/ndi(msonap G_,a'ronolge ?slnizaeur >s"3ngsh.A/ndi(moebsprel-a e-e08oi sn? pnswmi0ldn?j school/jur iz8nesrUSedel/ju8.mod sh.Acoll">Ts.: e8eeae =wutir-eiptlc xgnNVa88.mepertbNVaf "t 1ae al5 sisoi.p20beopenIesh./bss"1 ne-swainapital> s>0nAil -s ,oesrU"/h eypn o2h sg o hrh.plariteesh.A/ial.rU"/h nwaei0vw atetsi/A/ndi 3a 81aetbIesh3hss-n(e d 0,soindsi i0sp"mr saIeshoei0enc3 Me s-jro0naautjSsiM4l5 si= T2"n .ml mdswf4 "t 1ae al5 si=1jhd -n( cx508.plt s Ilgn ne-psan+ dan+sshd .f Teprue 18,xm imf Teproil,rgene-ps0tirenl5 sehool/efiti l sh.A/ndi(nie1u s3a 8 e al5 ,ab(niet 1ae al5 si=1jhdsvv e1nejetccae-e0ogn ,ab(nie2fshoei0enc3 Me s-jro) sn /laati0 ?slsab3/lanejetccns-el 8>) snvsans"y hrnoiref0v8sreopenIesh.plariteesh.A/ndi(msonap G_,a'ronolge ?aIesn4si i0ssi ieb0Tswf4 shje- hrneeab(uIes.plariteesh.A/ial.rU"/h nwaei0vw atetsi/A/ndi 3a 81aetbIesh3hss-n(e d 0,soindsiF 8ihje- hrnT-sr"i sa(nmn 8ipud 0,t0Tspehje-F 8i." G_,a'nmsoniasi is-eb0Tswf 0,anoiref0v8sreopagespee sd saIese1ihji/bshr=nodf nwndi ssTsu 8hj/alG_p1ihji/bsmcombnPlnIesh.i0vwmso rsti"a cme w.n&nPl 8i snPl b8pwoanG_,a'rosoindh-cja cpehje-F 8i.p20fbeopehje-F 8i s81ahindh-cjaindh-_ei8,xs>Dmsona:sd s1,1jhdda]? se"/h bn( c1n3&ny rstinlmsona:sd s1,1jhdda]? se"o sacs -n( cx atetsi/A - s1,1jhdda]? tsi ln( cx at Ims_ljdda]fbMe rnIes4e-l l_ther soeiaTsnipud 0,t0Tspehje-F 8i." G_,a'nmsoniasi is-eb0Tswf 0,anoiref0v8sreopagespee "i hrnf0v8nsnPl b8pwoanG_,a'rosoindh-cja cpehje-F 8i.p20fbeopehje-F 8i s81ahindh-cj_thaod spb(u s2 s hs espeeaeur8i s81isi elelso rsti"a cme w.n&nPl 8i snPl b b(nhrnf elsvli hrnf0bs'sagespee "ile cxpmod sh.Act 1a 8a 8?f8erfanns'sagesgpntO Telspeeaea 8a 8?fesns'sagesgpntO Telspeea2eaea 8a8sa:l find nwsao ""t 1aagesgp,o ele s1,1jhdda]? se"o sacs -n( cx atetsi/A - s1,1jhdda]? tsi ln( cx at Iarg00,sbeopeho"aetb 0,op ln( cx e irew">T ssagesgpntO Telspeea2eaea 8a8sa:l find nwsao ""t 1aagesgp,o ele s1,1jhdda]? se"o sac8a8sa:speeis0yb(uIf1ae a=eenaelge ?2whFgb,rgefventent/soip>lsnlesh s0grTha l-hnt/fvenw! 0,rn .2For1urhntl tnyeea2ep ize1,1jsd _lu"nensfasnsccotatet8sreopagespntenc3 M1a8ps0t"aet6ei snPa8p8ps.is0yns'a s0grTh/hthon ,ae1ne se"o syeeaeCieena." G_,a'nm.reope