Is It a Cold or Is It Whooping Cough?

At first it starts with a cold and a mild cough that doesn’t go away. Then it gets worse – especially at night – and you find your child gasping for breath when he coughs.

Is it a Cold or is it Whooping Cough?

Cara Barone, M.D., a pediatrician with the Palo Alto Medical Foundation, (PAMF) sees many parents struggle with this question. “Whooping cough, also called pertussis, is a constant concern for parents,” she says.

Parents have good reason for concern: Colds and pertussis begin with similar symptoms, so it’s hard to tell the difference at first. But whooping cough is a highly contagious disease that gets worse after a few weeks, while common colds improve. People develop uncontrollable coughing fits that make it hard to breathe. In rare cases, especially in young babies, it can be fatal.

The disease is caused by the bacterium Bordetella pertussis, and tends to run in three- to four-year cycles. Charles Weiss, M.D., MPH, an urgent care specialist and the chair of the Infectious Disease Committee at PAMF, has tracked pertussis outbreaks closely. In 2013, there were 1,904 cases of whooping cough reported in California, he says. That is nearly twice the number as in 2012. Then, in 2014, the number of cases increased five-fold with 9,935 cases of pertussis reported to the California Department of Public Health between January 1 and November 26, 2014.

Drs. Barone and Weiss say there are two key ways parents can protect their families.

1. Get vaccinated — Although the vaccine is not 100 percent protective, it significantly lowers the risk of getting the disease. It also lessens the severity of illness if you get sick with whooping cough, and reduces the odds you could spread it to others.
2. Know the symptoms — Proper care with antibiotics may help lessen symptoms. Antibiotics also help contain the illness, making your child less contagious. That’s critical to controlling community outbreaks.

What to Know About the Vaccine

The whooping cough vaccine, DTaP, came out in 1997, and causes fewer side effects – notably, less fever – than the older version (DTP), Dr. Barone says. The vaccine is the best protection out there for your family. However, its immune protection doesn’t last as long as the older version.

Scientists are studying the optimal schedule for the vaccine and boosters. Until the research is done, they recommend the vaccine for babies and toddlers, and a booster shot before adolescence.

Children should get five doses of DTaP: At 2, 4, and 6 months, another as a toddler, and another before age 6. Around age 11 or 12, children should get the booster shot, Tdap. The median age of PAMF patients with whooping cough in the 2013 outbreak was 13, partly because some children didn’t get the booster shot.

Doctors also recommend every pregnant woman get the Tdap vaccine between weeks 27 to 36 of gestation each time she’s pregnant to pass immunity on to her newborn. Babies under 3 months old are at greatest risk of dying if they catch whooping cough.

“Vaccinating mothers in pregnancy is the best approach we have at this time to saving infant lives,” Dr. Weiss says.

Warning Signs of Whooping Cough

Pertussis starts with cold-like symptoms – a runny nose, mild cough and perhaps a low fever. After one or two weeks, however, the disease can cause so much inflammation in the airways that a child has violent and rapid coughing fits, called paroxysms. Children struggle to breath in air, causing the “whooping” sound that gives the disease its common name. Many children also vomit during coughing fits. Rarely, a child can even pass out, fracture a rib or stop breathing during severe coughing. This violent cough can last two weeks or longer.

“It is a terrible, terrible cough, and a miserable sickness,” Dr. Barone says. “If your child is coughing in spasms, or breathing fast, or you can see your child’s ribs outlined when she breathes, your child definitely needs to be seen by a doctor.”

Infants with pertussis don’t always have the classic whooping cough. Instead they may have “apnea,” a pause in breathing. If a baby has cold symptoms and any difficulty breathing, get to the doctor.

“We are very tuned into the problem of pertussis and we have a low threshold for testing,” Dr. Weiss says. “If it’s pertussis, we’ll likely find it.” Pertussis can be diagnosed with a simple test in your doctor’s office.

When Parents Do Their Best

“Most people who’ve vaccinated their children know they’ve done their best,” Dr. Barone says. Still, it’s possible for a vaccinated child to get the disease. “Be reassured that if your children do get whooping cough, they probably won’t get as sick as they would have otherwise.”