My 16 Year Old Son Has Suffered More Than 7 Weeks With Pertussis
Nov 10, 2016

This guest post was written by Carolyn who works as a Home Health Community Nurse and who originally shared her son’s story on the Nurses Who Vaccinate blog to help raise awareness of the symptoms and dangers of pertussis.

My son is a healthy 16-year-old, middle linebacker for his Varsity football team.  He jet skis, is an avid boater, plays lacrosse, and enjoys working out, eating healthy and exercising.  I never suspected he would suffer with a vaccine preventable disease.

His cough was mild at first. Not a nagging cough, not a wet cough, just a mild cough. I asked my son if he was feeling well and although he said he was fine, I gave him cough syrup and took his temperature.  It was normal (hint #1) and we both went to sleep, although I did hear him cough occasionally through the night.

This marked the beginning of the longest 7 weeks of our lives.

The occasional cough continued for a week, but then I noticed it was worsening, and it was making him very short of breath. One day he called me from school and asked me to pick him up. I took him to urgent care, where they diagnosed him with bronchitis, gave him amoxicillin, put him on a five-day dose of prednisone and gave him an inhaler.

That night was the beginning of the nightmare.  He coughed so violently that he became short of breath.  He was gasping and choking and even began vomiting (hint #2).  This continued through the next day and night. He was exhausted. I was exhausted. And even though I am a nurse, I felt helpless.

I took him to the local Emergency Department where the pediatric physician prescribed an albuterol nebulizer and a chest X-ray. The chest x-ray came back crystal clear (hint #3).  When I questioned the doctor about the vomiting, they suspected it was due to a gag reflex, but they decided to give him saline for dehydration and take blood and urine samples.

All of his blood work came back fine except for his neutrophils and his monocytes which were only slightly elevated (hint #4). They treated him as a case of atypical pneumonia and put him on a five-day dose of Zithromax and advised us to continue the prednisone until finished.

During the next 10 days, as he completed the medications, my son continued to have these bouts of uncontrollable violent coughing, always resulting in vomiting, choking on phlegm and gasping. He was eating, but also losing weight, and he was in and out of school, often due to being up all night coughing.

One evening he vomited in the basin where I noticed black stringy flecks.  I immediately thought it was blood, but he assured me it was something he had eaten.  The next morning he vomited again, and this time it was phlegm with blackened red strings (hint #5). I put the vomit in a baggie, put him in the car and took him back to the emergency room.

His sample tested positive for blood and so they gave him several nebulizer treatments, upped his prednisone, repeated the chest x-ray (which again came back clear), prescribed the inhaler every four hours and released him.  With the increased prednisone, the cough did slow down a bit, but he still was vomiting phlegm and gasping, so I made a follow-up appointment with his physician where they did a thorough exam and diagnosed him with pertussis.

Pertussis? Really?  How did my healthy kid get whooping cough? I was diligent in getting him vaccinated.  How did three different doctors miss this?

Several days later the lab results were returned and in fact he had bordetella pertussis. A nurse from the Department of Health went over my son’s symptoms and created a timeline. She was convinced he was exposed in mid to late August, most likely from another child during practice or at the gym.

She explained that the pertussis vaccine is our best defense against pertussis, but that immunity tends to wane over time. She also explained how we all rely on community immunity to protect us from vaccine preventable disease.  When a large percentage of people are vaccinated, immunity is high and the risk of diseases like pertussis is lowered.  However, when people miss booster shots or purposely decline vaccines, the community can become more vulnerable to outbreaks.

While vaccinated individuals, like my son, can still get pertussis, their symptoms are usually milder than those who are unvaccinated, and they are less likely to end up hospitalized or dead as a result of infection.

Here are some important things I’ve learned:  

• Pertussis is a highly contagious and dangerous respiratory disease that is easily spread by coughing, sneezing and contact with saliva.

• Pertussis is more commonly known as “whooping cough” because of the sound that is sometimes made when gasping for air after fits of coughing.

• There are 3 stages of pertussis infection:
  • Stage 1 (1-2 weeks) includes mild upper respiratory symptoms, occasional low-grade fever, and slight cough which mimics a cold.
  • Stage 2 (6 or more weeks) includes spasmodic coughing episodes that are sometimes followed by long whooping sounds and may also involve vomiting, gagging, or facial color changes after coughing episodes.
  • Stage 3 can extend from weeks to months.  Although the infection is not contagious after appropriate antibiotic treatment, coughing episodes can persist which is why pertussis is often referred to as the “100 day cough”.

• Pertussis can be life-threatening, especially to babies, and can cause serious illness in children, teens and adults. About 90% of deaths from pertussis are in infants less than 1 year old.

• Vaccination and booster shots are the most effective way to prevent pertussis. Infants are recommended to receive five doses of DTaP, and adolescents and adults should get Tdap boosters.

• The CDC recommends that pregnant women get a Tdap booster vaccine as early as possible between the 27th through 36th week of pregnancy.  This helps pregnant women pass antibodies on to protect their babies, while also protecting mothers and making it less likely that they will transmit whooping cough to their newborn during or after delivery.

 

 

Pertussis is difficult to diagnose, as we experienced first hand.

Doctors don’t always suspect pertussis, or readily identify the symptoms.  And people can unknowingly have the disease and potentially spread it to those who are unvaccinated, too young to be vaccinated, or whose vaccine induced immunity has waned (like in the case of my son).  What’s worse is that treatment does not alter the course of disease, though it can reduce the infectious period.  You are no longer considered communicable once you complete the course of antibiotic therapy. However, it is recommended that you remain contained for at least five days after completing the full course of antibiotics.

It is my hope that healthcare providers will be more diligent in identifying pertussis cases sooner, and that parents will become more familiar with the symptoms to be able to identify when there is reason to be concerned.  My son had every sign and symptom, yet three different doctors missed the diagnosis while we continued to seek treatment over the course of four weeks.  By identifying pertussis sooner, we can help reduce the spread of the disease and the long-lasting symptoms in patients.

The past seven weeks have been challenging, but we’re finally seeing improvement.  My son is still coughing a lot, but he’s no longer vomiting and no longer contagious.  He’s eating, has returned to school and is planning to return to football.

A letter has been distributed to all the families in his school so that others can be on the lookout for the signs and symptoms of this dangerous disease.  And of course, everyone we know to have had close contact with him has been alerted to the fact that they could have been exposed.

So far no one else has shown signs, although believe me, I listen to every cough a little differently now.  Now that I know how scary and persistent pertussis can be, even among a vaccinated adolescent, I don’t want anyone else to have to go through what our family has. Get vaccinated for best protection, but remain vigilant.  

Every Child By Two (host of the Shot of Prevention blog) welcomes guest blog posts on a variety of vaccine related issues.  The views and opinions expressed in these guest posts do not necessarily represent the views of the Every Child By Two organization.

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