When 5-year-old Brian Ray’s cough left him gasping for air and vomiting at night, his mother knew what the problem was: Whooping cough. Caroline Ray knew because she had whooping cough at age 12.
"My mom didn’t know what I was going through. With him, I knew," said Ray, 28, of Gilbert. "It’s scary. You’re trying to catch your breath and you can’t."
Since he was diagnosed with pertussis — also known as whooping cough — and started taking antibiotics two weeks ago, Brian’s cough has nearly disappeared.
The battle against Arizona’s whooping cough outbreak, however, has just begun.
State and county health officials have asked health care providers to ramp up vaccination efforts among infants and adolescents, and many doctors are preparing to comply.
"There’s an outbreak, so you (consider getting) the vaccine in them as soon as you can," said Dr. Gary Auxier, a pediatrician.
Auxier said his practice, Gilbert Pediatrics, will probably follow state and county recommendations that infants get their first pertussis vaccination, which is typically combined with diphtheria and tetanus vaccine, at 6 weeks of age, followed by shots at 10 and 14 weeks.
Currently, pertussis vaccinations are given at 2, 4 and 6 months of age.
Recommendations for the last two shots before children start school remain the same at 15 to 18 months and 4 to 6 years old.
By accelerating vaccination schedules, public health authorities said they are trying to protect children younger than 1 year, who are more likely to be hospitalized and die from the disease.
A 27-day-old infant from Maricopa County died from whooping cough earlier this year.
"We realize there will be a temporary burden on health care providers, but they’re our biggest asset in this," said David Engelthaler, state epidemiologist. "We have to focus our attention on adults and adolescents. They’re the ones that keep (pertussis) going and infants take the brunt of it."
The outbreak was declared last month, when health officials reported a leap from fewer than 300 pertussis cases statewide last year to about 400 cases so far this year. In Maricopa County, whooping cough cases have climbed to 194 so far this year from 82 at this time last year. Cases among children ages 9 to 19 have increased the most, at about four times their numbers last year.
Adolescents who were immunized as children become susceptible to whooping cough because the vaccine’s effectiveness begins to wane after several years, said Doug Campos-Outcalt, the county’s interim health officer.
Because the condition seems like nothing more than a persistent cough, many children and adults get whooping cough but are never diagnosed, he said.
Either they don’t go to the doctor, or their physician does not test for pertussis.
As a result, the number of pertussis cases in Arizona is vastly under-reported, Engelthaler said. "We know we’re only seeing the tip of the iceberg."
The U.S. Food and Drug Administration has recently approved the use of a pertussis booster in adolescents, which will be available to health care providers this month. The state health department, which has ordered the vaccine and will make it available to county health departments, recommends that doctors vaccinate adolescents who have contact with infants inside the home, and who have not had a tetanus shot in the last five years. The new pertussis booster is given with vaccines for diphtheria and tetanus.
Dr. Mary Rimsza, a pediatrician practicing in Phoenix, said she plans to begin vaccinating adolescents for pertussis once the vaccine is available.
"It will help them, prevent them from getting (pertussis), but the most critical benefit is if we immunize this population, they’re not going to spread it to infants," she said.
Babies cough so hard from pertussis they can die from ruptured blood vessels in the brain, suffocation from mucus they can’t cough up or pneumonia, Auxier said.
"They cough their brain out, literally," he said. "It’s a horrible death."
Ray said she wishes her son had been vaccinated from pertussis, but she’s glad she knew the signs of whooping cough.
"If these babies are dying from it, I think children should be vaccinated," she said.
Pertussis, or whooping cough
The facts: Some signs and symptoms of whooping cough:
• A bacterial respiratory illness that got its name from the whooping sound made from gasps of air between coughs
• Transmission: Typically by breathing in airborne droplets from an infected person’s cough
• When to see the doctor: When a cough lasts more than two weeks
• Common treatment: Antibiotics for patients and their household contacts
Source: Arizona Department of Health Services