Whooping cough. You probably haven’t thought much about it in a while, maybe never. And is it “Hooping” or “Wooping?” I looked it up in Webster’s and still don’t know. Anyway, this is an infection that’s been around for a while. It’s caused by a bacterium called Bordetella Pertussis, hence it’s medical name “pertussis.” It typically affected young children, causing an upper respiratory infection that is characterized by a loud, inspiratory “whoop” and can be dangerous in the very young. Adults can get the infection as well, but typically don’t have the “whoop.”
We haven’t seen much of this due to the effectiveness of a vaccine introduced decades ago – DTP. This protects against diptheria, tetanus, and pertussis, and we’ve all probably had it. The problem is that as we age, our immune systems forget about the pertussis part (tetanus boosters – Td – protect against tetanus and diptheria, but not pertussis). And now we’re seeing more and more cases of whooping cough, mostly in adults. In fact, we are awaiting confirmation testing on a couple of suspicious cases we’ve seen in our clinic right here in Rock Hill.
Why is this important? For a couple of reasons. First, this causes frequent, forceful coughing, usually lasting weeks or longer. Aside from being a nuisance, the coughing can be dangerous, leading to some significant problems: collapsed lungs, broken ribs, dissecting blood vessels in the chest and neck. And adults can pass the infection on to infants. As mentioned earlier, adults don’t typically have the whoop, but they do have bad coughing that won’t go away, and for some reason patients have irritated, watery eyes. That should be a red flag. If caught early (within the first two weeks), antibiotics might be of help. Certainly there is effective cough medicine that can provide relief, and a diagnosis needs to be made so the infection doesn’t spread.
Here’s where it gets a little interesting, and very troubling. Troubling because it sheds light on the disconnect between what we know and what we do, or specifically what the medical community knows and recommends and what our healthcare system covers. (Remember, this is the same system – insurance companies, Medicare, Medicaid – that considers it more prudent to cover lung cancer, heart disease, and strokes than medication that helps people stop smoking.)
So here’s what we know: our immunity to whooping cough is waning as we age. There is an effective vaccine available (Tdap) that boosts immunity for tetanus, diptheria, and whooping cough. It is recommended by infectious disease organizations as the state-or-the-art practice regarding immunizations. It’s expensive: almost $40, twice as much as the Td booster. And guess what? Medicare and Medicaid don’t cover it. And private insurances do so only if you have vaccine coverage. Not covered by Medicare, the very age group where we are seeing the greatest incidence of this infection.
So there’s a public health dilemma. We know the problem, we know how to fix it, but we won’t cover it.
Now here’s a difficult topic, but one that’s important and bears considering on a regular basis: Sudden Infant Death. There are few things more tragic than dealing with the unexpected death of a healthy infant. But it happens – 4,000 times a year in this country. A lot of the time it happens for no apparent reason. But here’s something we do know: somewhere between a third and a half of these deaths are due to suffocation. That’s important because suffocation should be preventable. If you have a young child, grandchild, or friends with infants, here’s a list of the risk-factors for Sudden Unexpected Infant Deaths due to suffocation:
- placement on an adult bed, couch or chair or other surface not intended for infant sleep
- sleeping on the abdomen or side
- sleeping with an adult
These are things we need to be aware of and share. This is one of those times when an ounce of prevention is worth a life-time of regret.
Add Comment