TOPICS > Health

Whooping Cough: Killer Cough

September 22, 1997 at 12:00 AM EDT


ANNE LENNIS, Mother: (talking to two-year-old son kicking ball around yard) There you go. Get it buddy. Get it. Go, Derek, go! Get it.

LEE HOCHBERG: Two year old Derek Lennis spent the late Idaho summer like most healthy kids, kicking the ball around, playing in the yard. But his mother says his spring times had been much different.

ANNE LENNIS: He looked like he was sick, just worn out looking, like very tired looking, worn out, coughing all the time, just all day, all night.

LEE HOCHBERG: The two year old was one of 460 Idaho residents and thousands of Americans who caught whooping cough this spring. A two-month-old Idaho child died. Parents say the outbreak hit with a fury.

ANNE LENNIS: It happened very fast. It wasn’t just like a one here, or one there. It was like there were 20 here and then there were 10 more and 5 more.

LEE HOCHBERG: The U.S. is in a peak phase for whooping cough, with almost 8,000 cases last year, twice the usual. Local outbreaks have occurred in Idaho, California, Ohio, and New York. The highly contagious respiratory tract infection, also known as pertussis, is spread by contact and marked by violent coughing spasms that can cause choking, brain damage, and death. Three hundred fifty thousand people die of the bacterial disease every year worldwide. In 1938, it killed 9,000 Americans. But the introduction of vaccine brought case numbers down to 1,000, and deaths in the U.S. to only three by 1991. Now, says the director of Idaho’s Panhandle Health District, pertussis is making a comeback.

LARRY BELMONT, Panhandle Health District: People kept coming in. We kept getting calls. We kept getting more need for more help, and it was overwhelming.

LEE HOCHBERG: Epidemiologists from the Centers for Disease Control and Prevention are unsure what’s causing the increased disease. They traveled to Coeur D’Alene, Idaho, to interview people who contracted it.

SPOKESMAN: Maybe we’ll have two people or two cars at least going around to see if we can find them.

LEE HOCHBERG: The CDC recommends children get four doses of diphtheria, tetanus, pertussis vaccine, or DPT, by age two. Nationally, 79 percent of children do that. But the rate in Idaho is only 66 percent, the lowest in the country. Almost half of under-vaccinated pre-schoolers get pertussis, and Coeur D’Alene family physician Dick McLandress says he’s confounded by parental failure to immunize.

DR. DICK McLANDRESS, Panhandle Health District: Parents have simply chosen not to come in to get their children immunized. I think that’s the major reason. It’s simply parental laziness or neglect. What there is, is this failure to understand that whooping cough, that pertussis was a major killer of children in the years not too long ago.

LEE HOCHBERG: McLandress says the failure to immunize is especially frustrating since the federal government provides vaccine free of charge to the low income. Parents tell him they’re afraid of the side effects that accompany 50 percent of DPT shots: pain, fever or swelling. The managing editor of the Coeur D’Alene newspaper says he hears another fear from his readers, fear of government-endorsed immunizations.

MIKE FEILER, Coeur D’Alene Press: You hear a lot of people that say, yes, I’d get shots but I don’t want the government having to tell me I have to do this next week or do this tomorrow and so on. And so I think it caught up with a lot of people, you know, not realizing a lot that the days are gone when you go back and live in the hills for two years without coming into contact with somebody else.

LEE HOCHBERG: Failure to immunize, though, could be just one part of the puzzle. While it’s true that not immunizing children could leave them wide open to pertussis, some who are immunized are also getting the disease. Preliminary CDC data shows 80 percent of the children with disease in the Coeur D’Alene area had been immunized. Anne Lennis’s son, Derek, was completely up to date on his shots.

ANNE LENNIS: I was shocked. I never even thought that he could possibly get it because he’s had all of his immunizations.

LEE HOCHBERG: At the day care Lennis attended at Coeur D’Alene’s Kootenai Medical Center six other children and a staff member got pertussis. All were up to date on their immunizations. Daycare coordinator Pam Thompson.

PAM THOMPSON, Day Care Coordinator: Because we’re health care based we take a lot of precautions. I mean, we’re sterilizing toys, we’re using gloves, changing children. We’re washing everything down. We’re sterilizing the life out of things. We felt like we did everything we could. And we still had seven cases. You wonder was the immunization effective, maybe the vaccine wasn’t effective.

DR. MEHRAN MASSOUDI, Centers for Disease Control: It’s not an easy thing to do to find out if the vaccines that have been given were, indeed, not viable. There is no evidence to suggest that previously, nor this time, however, it could occur. It is a possibility.

LEE HOCHBERG: The CDC’s Massoudi says he believes the vaccine is working because even if there are more pertussis cases, they are generally not serious. He says the vaccine fails to impart full immunity 10 to 30 percent of the time, but even in those cases it carries the benefit of making the symptoms of pertussis less severe if children do contract it.

DR. MEHRAN MASSOUDI: We have had pertussis; however, it has been much more mild. And it could have been much worse if the pertussis coverage–the vaccination coverage was not as high as it was. Hospitalization rates have been very low, less than five hospitalizations. And I consider that a success.

RICHARD HOLBROOKE: Researchers say the real problem with the vaccine may be that its effectiveness seems to be waning as children grow older. Epidemiologist Paul Stepak of the nearby Spokane Health District found many local teenagers have lost their immunity to pertussis. They may suffer only a nagging cough but transmit the disease to youngsters, to whom it is far more dangerous.

DR. PAUL STEPAK, Epidemiologist: You have a vast reservoir of adolescents and young adults with mild inter-current pertussis infections who can serve as a means of exposure and transmission to many other people. If I were a betting man, I’d bet big that you would find many cases.

LEE HOCHBERG: Two out of ten pertussis cases are adults, higher than in the past. The situation is aggravated in places like Coeur D’Alene, a tourist town, with many low-wage jobs with no sick time. Public Health Nurse Randi Russo.

RANDI RUSSO, Public Health Nurse: A lot of the people that are employed in our town are kind of minimum wage folks. They can’t endure the loss of pay. They are coughing for weeks on end. They’re in our shopping malls. They’re in our movie theaters. They’re in our schools. They’re afraid they’re going to lose their job, so they go to work anyway. And while they’re at work anyway, they’re spreading the disease.

LEE HOCHBERG: Russo says employers have not responded to health district requests to reconsider sick leave policy. Doctors, meanwhile, have no strategy of their own for fighting pertussis in adolescents and adults, besides antibiotics. If it’s not going away, the only way to protect children from it may come back to immunizations.

DR. PAUL STEPAK: As for what needs to be done in that regard the answer is blessedly simple. We need to be completely vigilant on the issue of getting children vaccinated.

LEE HOCHBERG: Together with the local Rotary Club Idaho’s Panhandle Health District has started an incentive program to get kids immunized, rewarding families who complete the full regimen of vaccinations with a free potty seat. The CDC, meanwhile, is advocating that child immunizations be offered nationwide at places where parents receive public assistance. The agency also hopes that a newly available pertussis vaccine, called DATP, might make immunizations more effective.

DR. PAUL STEPAK: They may produce a better quality of immunity, so to speak, in those who are vaccinated. And also, because its adverse reactions are so much less, it may be much more acceptable. And so we’ll have improved vaccination levels to protect our population.

LEE HOCHBERG: But after a year’s use of the new vaccine, there’s been no change in immunization rates. Doctors are considering adding a new booster shot for adolescents to combat waning immunity, but there may be little else they can do.

DR. PAUL STEPAK: Until vaccine programs can more aggressively reach people who need to be immunized, you can expect that there will be outbreaks of pertussis in many communities, perhaps all communities.

LEE HOCHBERG: The CDC expects to issue its final assessment of the Idaho outbreak later in September.