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Let’s Talk About Pertussis Also Known as Whooping Cough

Written by Richard Lander MD FAAP

What is pertussis?

Pertussis is an infectious disease caused by bacteria. Sometimes referred to as the hundred day cough, it can be quite debilitating. The cough is persistent and recurs day in and day out. Once you hear this cough, you will never forget it. The cough is repetitive, easily lasting 30 seconds or more and has a whoop sound at the end of it. This whoop is what gives rise to its popular name whooping cough. If you are curious, you can hear the whoop sound on the internet.

Who gets Pertussis?

Many people do-all ages and from all walks of life including: young children, teenagers, adults in middle age and senior citizens.

Is Pertussis contagious?

Yes it is. I have seen Pertussis several times in my practice this year. I have seen it spread from mother to child, among siblings and even from teacher to students.

Treatment of Pertussis

There are different phases of Pertussis. When the diagnosis is made during the first phase of the illness, it can be treated with antibiotics. This may shorten the duration of the disease. Otherwise physicians can offer supportive care and medication to help the patient sleep.

Prevention

Pertussis is preventable by a vaccine. This vaccine, DPT (Diptheria, Pertussis and Tetanus) is typically given during childhood. The vaccine is given as a series of three injections in the first year of life, a booster during the second year of life and another booster before the start of elementary school. An additional booster is given at 11 year of age.

Because this last vaccine is relatively new, many children older than 11 year of age will be receiving it. Additionally the Tetanus booster which has always been recommended to be given every ten years has been change to include the Pertussis vaccine.

Therefore, adults of almost all ages are urged to obtain it even if you received a Tetanus booster a year ago. Many hospitals across the country are giving the vaccine to new mothers right after delivery and in some progressive hospitals the vaccine is being offered to new dads and to grandparents.

With this approach the State of California, which had seen deaths from Pertussis in the last few years, has dramatically decreased their rate of Pertussis. These dramatic results have persuaded many pediatricians to offer this vaccine to parents and grandparents of their patients.

Why talk about Pertussis now?

Pertussis is on the rise in the United States. From January through March in 2012 there were seven times the number of cases seen in Washington, D.C. than in the same time frame the year before in 2011. So why you might wonder: why this rise in Pertussis now? Several years ago we experienced a number of parents refusing to have their children vaccinated against childhood diseases including Pertussis.

These refusals were based on fears of the vaccines and components of the vaccines such as aluminum or mercury. Thankfully, these fears have been proven to have been unfounded. Unfortunately, once people stopped vaccinating their children, herd immunity was lost.

Herd immunity is gained when a majority of people in a geographic area receive a vaccine. These vaccines then protect even the few who were not vaccinated.

As the number of vaccine refusers climbed, we lost herd immunity. Hopefully today with increased knowledge through education, the number of vaccine refusers is beginning to decline and more people are again protected against infectious diseases such as Pertussis. Scientists are working tirelessly looking for clues to currently unanswerable medical questions.

Every day they race the clock in an effort to look for a treatment for currently untreatable medical conditions and diseases. Pertussis is not one of them. Pertussis is preventable with a vaccine It is criminal that there are people living in the United States in 2012 suffering from a disease they did not have to have. Please don’t be one of them. Ensure that you and your loved ones do not get Pertussis. Get vaccinated! Get vaccinated now!

Dr. Lander has been practicing pediatrics for 32 years in New Jersey and is the immediate past chairman of the American Academy of Pediatrics Section on Administration and Practice Management.  He says if he had to do it all over again he wouldn’t hesitate to be a pediatrician.

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How Should the Doctor Know?

Written by Dr. Nelson Branco

Last week, a family asked for my opinion on whether they should have a third child. Truthfully, my first instinct was “How should I know?” but of course, that’s not what I said. It’s a fair question, considering that I have three kids myself, and I know a thing or two about families and kids. But it’s a very personal decision, and one that this couple was obviously taking very seriously. After spending a few minutes giving them the most thoughtful answer I could come up with, I went on to the next patient and the next set of questions.

But the moment stuck with me because it illustrated in a concrete way that I have a special role in the lives of my patients and their families.

When I meet with parents-to-be for a prenatal visit, I tell them that I give advice, and they make decisions. I am full of advice and opinions (ask anyone) but ultimately they have to decide on bedtimes, rules, discipline, sleep training, diapers, feeding, and the many decisions to be made when you’re a parent.

When I was a kid, there were a few people whose opinion was sought out and respected because of who they were – doctors, priests and teachers. Others had to earn respect on their own merits. Times have changed, and I live in a different community than the working-class immigrant community where I grew up.

My opinions and advice have to stand on their merits, and I have to earn the respect and trust of my patients and their families.

I wouldn’t have it any other way, and neither would your pediatrician, I’m sure.

I don’t live in a particularly small town, but our community is small enough that I’m frequently recognized by patients or parents. I enjoy it, but my kids sometimes complain – “Wherever we go, you see one of your patients!”. It’s not like being a rock star, but I do have to mind my manners in public, and I’m sure to be asked to examine at least one rash if I venture out to a school event or the farmer’s market.

A few weeks ago, that didn’t work out so well. Riding home on my bike, I passed two of my patients standing on their front porch. I waved, which meant that when the the Prius (quietly) came around the bend, I didn’t have my right hand on the brake lever. Anyone who has ever ridden a bike can predict what happened next.

Too much front brake sent me flying over the handlebars.

Of course, I was wearing my helmet so I can now speak with even more authority about the importance of wearing one. Unfortunately, the helmet didn’t stop me from breaking my elbow (radial head). The person driving the Prius stopped immediately to see if I had survived. This being Marin County, the herbs and potions capital of California, she immediately offered me Arnica to apply to my wounds. I deferred. Didn’t want to delay the x-ray and pain medicine that I knew were in my future.

So the doctor became a patient, and I spent a few weeks explaining to parents why I am examining their children one-armed. I know that they appreciate that I am there, and to be honest I never considered staying home from work – who would tease me about my bike crash otherwise?

Last month, my colleague Dr. Sprayberry posted “Why Your Doctor Chose to Be Your Doctor.”  He talked about the sacrifices medical students and residents make to become doctors, and how much strain that can put on us personally, and on our families. We do it “to help people” as he puts it, but it’s much more than that. I go to work each day to listen, advise, assist and amuse. I know that I am a part of my community and of my patients’ lives because they are a part of mine. I hope you can say the same about your job. Like I said, I wouldn’t have it any other way.

Dr. Branco is a practicing pediatrician in the San Francisco Bay Area and is very active with the local chapter of the AAP.