Whooping cough making a comeback

S. Quarles van Ufford-Thomson, Contributor, Jakarta

Considered a disease of the past, whooping cough is staging a comeback, posing a threat to babies in communities throughout the world, including Jakarta.

Spread by bacteria through the air, whooping cough causes mild cold symptoms or a nagging cough in adults, but can be fatal for infants, especially those under one year of age.

Once infecting millions of people each year, whooping cough was greatly curbed by a vaccine developed in the 1940s and subsequent global immunization programs. Six decades later, the incidence of whooping cough is again on the rise.

The Center for Disease Control in the U.S. reported a 51 percent increase in reported cases during the 1990s from the 1980s with 7,867 persons diagnosed in 2000. In 1997, Australia registered 10,699 cases of the disease. Epidemiologists estimate that the actual number of cases could be ten times higher than the reported cases due to the difficulty in diagnosing the disease among adults.

Although the disease has textbook symptoms in infants, some doctors fail to recognize them, leading to critical situations. I experienced this very situation in Jakarta a few months ago.

At that time, our four-month-old baby suffered from repeated coughing fits, which progressively worsened, leaving her gasping for air and blue in the face. I consulted four different doctors in the space of a week and a half at the private clinics of Medikaloka and SOS.

After I described my child's symptoms to each doctor with the great detail of a concerned mother, all four physicians diagnosed the common cold, prescribing various remedies from cough syrups to nose drops.

My daughter turned purple on the observation table of the fourth doctor, a foreign doctor at SOS, who reacted in this way: "Your baby just has a bad cold and every child coughs differently. I recommend that you go home and not give her any medicine at all. Is this your first child?"

Instinctively, I felt she had no cold. She had no cold symptoms apart from her coughing spasms, which often left her struggling to breathe.

Exasperated, I visited a fifth doctor the next day at the Australian clinic, after another torturous night. A stand-in doctor observed my daughter's cough and deemed her condition serious. A medical evacuation was ordered with still no diagnosis.

Within 24 hours, our baby was admitted to a hospital in Bangkok, with an immediate prognosis of whooping cough, later confirmed through observation and a nasal culture. She remained in hospital for a week, receiving antibiotics and oxygen during her coughing spasms.

Whooping cough begins as a mild upper respiratory infection with symptoms that may include a mild cough, runny nose, sneezing or a low-grade fever for a period of a week.

During the next stage of the disease, coughing is characterized by five to 15 rapid coughs followed by a characteristic high-pitched whoop, in which the face may turn blue or purple due to a lack of sufficient oxygen. Mucus is often thick and sticky and vomiting often follows the fit.

Coughing fits initially occur at nighttime but then also become increasingly frequent during the day with minimal or no fever. Symptoms in adults and immunized children are much less severe than those in infants.

The most serious complications of whooping cough include seizures, mental retardation and death.

The most effective way to control the spread of the disease is to maintain high levels of immunization in the community. Infected persons and all those people living in close proximity to the infected person should be treated with the antibiotic erythromycin, to prevent further spread of the disease.

Another preventative measure is through the vaccination of adults, especially those who are in close contact with infants, such as parents, infant care givers and health care workers. Ten years after receiving the last booster, adults are no longer protected against the disease and can unknowingly transmit it to infants.

At the very least, heightened awareness among doctors and parents of whooping cough and its ever presence in our community may help to save precious young lives.

The writer is an international development consultant and freelance writer with areas of specialization, which include public health issues.