Whooping cough

• Whooping cough, also called pertussis, is a highly contagious bacterial infection of the respiratory system that causes uncontrollable coughing. Whooping cough is caused by the bacterium Bordetella pertussis (or B. pertussis). The name comes from the noise made when taking a breath after coughing. Individuals may have choking spells or may cough so hard that they vomit.
• The bacteria are spread from person to person through tiny drops of fluid from an infected person's nose or mouth. These germs may become airborne when the person sneezes, coughs, or laughs. Other people then can become infected by inhaling the drops or getting the drops on their hands and then touching their mouths or noses. Infected people are most contagious during the earliest stages of the illness and up to about two weeks after the cough begins. Antibiotics shorten the period of contagiousness to about five days following the start of antibiotic treatment.
• Anyone can get whooping cough, but it has historically been more common in infants (younger than six months of age) and children ages 11-18 whose immune systems are not properly functioning or developed. Whooping cough is especially dangerous in infants. The coughing spells can be so bad that it is hard for the infant to eat, drink, or breathe.
• Before there was a vaccine, whooping cough was one of the most common childhood diseases and a major cause of childhood deaths in the United States, killing 5,000-10,000 each year. There are fewer cases today because there are both pertussis-only vaccines and combination vaccines for tetanus, diphtheria, and pertussis. If an individual is diagnosed with whooping cough, treatment with antibiotics may help if given early.
• The American Academy of Pediatrics (AAP) recently recommended that kids who are 11-18 years old get a booster shot that includes a pertussis vaccine, preferably when they are 11-12 years old.

• The incubation period (the time between infection and the start of symptoms) for whooping cough is usually seven to 10 days, but can be as long as 21 days.
• Symptoms of whooping cough typically last six to 10 weeks, but may last longer. Symptoms usually occur in three stages.
• Stage 1: Stage 1 symptoms include cold-like symptoms, such as sneezing, runny nose, mild coughing, watery eyes, and sometimes a mild fever, lasts several days to two weeks. An infected person is most contagious during this stage.
• Stage 2: During stage 2, cold-like symptoms fade, but the cough gets worse, changing from a dry, hacking cough to bursts of uncontrollable, often violent coughing. During a coughing episode, it may be temporarily impossible to take a breath because of the intensity and repetition of coughs. When finally able to breathe, the individual may take in a sudden gasp of air through airways narrowed by inflammation, and this sometimes causes a whooping noise. Vomiting and severe exhaustion often follow a coughing spell. But between coughing episodes, the infected person often appears normal. This is the most serious stage of whooping cough, usually lasting from two to four weeks or longer.
• Stage 3: During stage 3, the individual may improve and gain strength, but the cough may become louder and sound worse. Coughing spells may occur sporadically for weeks to months and may flare up if a cold or other upper respiratory illness develops. This final stage may last longer in people who have never received the whooping cough vaccine.
• Healthy adults who become infected with whooping cough often have a much milder form of the illness compared with children. But adults age 60 years and older are at increased risk of having severe symptoms and developing complications.
• The severity of symptoms is, in part, influenced by whether a person was immunized against whooping cough and how long ago the immunization was given.

• Diagnosing whooping cough in its early stages can be difficult to diagnose because the signs and symptoms resemble those of other common respiratory illnesses, such as a cold, the flu, or bronchitis.
• If whooping cough is the diagnosis, the doctor will advise the individual to avoid contact with others during recovery because the condition is highly contagious. It is important not to return to work until a doctor approves. Children should not go to school or child care unless a doctor clears the child.
• A doctor will also notify health authorities, including the U.S. Centers for Disease Control and Prevention(CDC), who keep track of whooping cough outbreaks.
• Sometimes, doctors diagnose whooping cough simply by listening to the cough. Medical tests may be needed to confirm the diagnosis, including nose or throat cultures, blood tests, and a chest x-ray.
• A nose or throat culture and test: A doctor will take a nose or throat swab or suction sample. The sample is then sent to a lab and cultured or otherwise tested for whooping cough bacteria (B. pertussis).
• Blood tests: A blood sample may be drawn and sent to a lab to check for a high white blood cell count. White blood cells help the body fight infections, such as whooping cough. A high white cell count typically indicates the presence of infection or inflammation. However, this is a general test and not specific for whooping cough.
• Chest X-ray: A doctor may want to use an X-ray to check for the presence of fluid in the lungs, which can occur when pneumonia complicates whooping cough and other respiratory infections

• Respiratory complications can be severe in infants and may include suffocation, also known as asphyxiation. Seizures can occur in infants who have whooping cough. Middle ear infection, inflammation, called otitis media, may occur. A form of pneumonia is a potentially fatal complication in an infected person of any age. Emphysema (a progressive lung disease that results in shortness of breath and reduces the individual's capacity for physical activity), cerebral hemorrhage (bleeding in the brain), and encephalitis (swelling of the brain) can occur. These conditions may be serious.
• Teenagers and adults (including older adults) usually recover from whooping cough without complications. Excessive coughing may cause a bruised or broken rib or a hernia (an abnormal protrusion of a loop of intestine through a weak area of abdominal muscle).
• Children with whooping cough also may injure the muscles of the chest wall or develop a hernia that needs to be treated with surgery.
• In infants, especially those under the age of two, complications from whooping cough are more severe and may include ear infections, pneumonia, slowed or stopped breathing, dehydration, seizures, and brain damage. Because infants and toddlers are at greatest risk of complications from whooping cough, they are more likely to need treatment in a hospital. In infants under six months of age, complications can be life-threatening. If an infant has a cough that has lasted for more than several days and has not gotten better, healthcare providers recommend seeing a doctor.

• Treatment for whooping cough varies, depending on the age and the severity of signs and symptoms.
• Older children, teens, and adults: When whooping cough is diagnosed early in older children, teenagers, and adults, doctors usually prescribe vaccination, bed rest, and an antibiotic such as azithromycin (Zithromax®) or erythromycin (E-mycin®, Eryped®). Although antibiotics will not cure whooping cough, they can shorten the duration of the illness and they shorten the period of communicability. If there is a confirmed diagnosis but a slow response to antibiotic therapy, it may be necessary to take the antibiotic for at least two weeks and maybe longer.
• If the illness has progressed to the point of severe coughing spells, antibiotics are not as effective but may still be used. Unfortunately, there are few medications that help provide relief from the symptoms of whooping cough. Over-the-counter (OTC) cough medicines, such as dextromathorpan (Robitussin®), generally have little effect on whooping cough. A case of whooping cough usually resolves in six weeks but may last longer.
• Infants and toddlers: Almost all infants with whooping cough who are younger than two months, as well as many older babies, are admitted to the hospital due to the potential severity and risks of whooping cough. Most babies treated for whooping cough overcome the condition without lasting effects, but the risk exists until the infection clears. In the hospital, the infant is likely to receive intravenous (IV or in the veins) antibiotics, such as erythromycin, to treat the infection and perhaps corticosteroid drugs, such as hydrocortisone, to help reduce lung inflammation. Sometimes an infant's airway may also be suctioned to remove mucus that is blocking it. The infant's breathing will be carefully monitored in case extra oxygen is needed. If the infant cannot keep down liquids or food, intravenous (IV) fluids may be necessary. In some cases, prescription sedatives (such as lorazepam or Ativan®) will help the infant rest. The infant will also be isolated from others to prevent the infection from spreading.

Note
: Currently, there is insufficient evidence available on the safety and effectiveness of integrative therapies for the prevention or treatment of whooping cough. The therapies listed below have been studied for related conditions such as cough and respiratory infections, should be used only under the supervision of a qualified healthcare provider, and should not be used in replacement of other proven therapies or preventive measures.

A

Strong scientific evidence

• Andrographis
  :
  Andrographis (Andrographis
  paniculata) has been widely used in Indian (Hindu) folk medicine and Ayurvedic forms of medicine. A combination of andrographis with Siberian ginseng or eleuthero (Eleutherococcus senticosus) called Kan Jang® may be effective for upper respiratory tract infection treatment. In clinical study, this treatment was given for five days, and was shown to improve fever, muscle soreness, cough, sore throat, and headache.
• Several cases of anaphylactic reactions, including shock, have been reported to the World Health Organization Collaborating Center for International Drug Monitoring as of June 2003. Avoid with infertility or patients actively trying to conceive. Use cautiously with diabetes, bleeding disorders, or high or low blood pressure or medications used for these conditions. Avoid if pregnant or breastfeeding.

B

Good scientific evidence

• Echinacea
  : Preliminary studies suggest that echinacea may not be helpful for prevention of upper respiratory tract infections in adults and children or treatment of upper respiratory tract infections in adults. Study results are conflicting and further research is needed to make a conclusion in this area.
• Avoid if allergic to echinacea, its constituents, or any members of the Asteraceae/Compositae family (ragweed, chrysanthemums, marigolds, daisies). Use cautiously in patients prone to atopic reactions and in those with hemochromatosis and diabetes. Some natural medicine experts discourage the use of echinacea by people with conditions affecting the immune system, such as HIV/AIDS, some types of cancer, multiple sclerosis, tuberculosis, and rheumatologic diseases (such as rheumatoid arthritis or lupus). Use parenteral preparations of echinacea
  (no longer approved for use in Germany) cautiously. Use tinctures cautiously with alcoholic patients or in patients taking disulfiram or metronidazole. Avoid in patients presenting for anesthesia. Use cautiously if pregnant or breastfeeding.
• Peppermint
  : Early clinical study has examined the use of menthol, a constituent of peppermint oil, for cough. More research on is needed to better determine effectiveness.
• Avoid if allergic or hypersensitive to peppermint or menthol. Peppermint is generally considered safe in non-allergic adults when taken in small doses. Use cautiously with G6PD deficiency or gallbladder disease. Menthol is generally considered safe in non-allergic adults, although doses greater than 1 gram per kilogram of body weight may be deadly in humans. Avoid if pregnant or breastfeeding.

C

Unclear or conflicting scientific evidence

• Andrographis
  : Based on clinical evidence, andrographis may be effective for upper respiratory tract infection prevention. Additional high-quality clinical study is needed to reach a conclusion.
• Several cases of anaphylactic reactions, including shock, have been reported to the World Health Organization Collaborating Center for International Drug Monitoring as of June 2003. Avoid with infertility or patients actively trying to conceive. Use cautiously with diabetes, bleeding disorders, or high or low blood pressure or medications used for these conditions. Avoid if pregnant or breastfeeding.
• Arginine
  : Early study suggests that arginine supplements may decrease the risk of respiratory infections. Large, well-controlled studies are needed to clarify this relationship.
• Avoid if allergic to arginine, with a history of stroke, or liver or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control blood sugar levels.
• Aromatherapy
  : Healing with fragrant oils has been used for thousands of years. Despite widespread use in over-the-counter agents and vapors, there is not enough scientific evidence to recommend use of eucalyptus aromatherapy by mouth or inhaled, as a decongestant-expectorant for upper respiratory tract infections.
• Do not use essential oils internally. Essential oils should only be used on the skin in areas without irritation. Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
• Astragalus
  : Astragalus is often used in Chinese medicine as a part of herbal mixtures to prevent or treat upper respiratory tract infections. Due to a lack of well-designed research, firm conclusions cannot be drawn at this time.
• Avoid if allergic to astragalus, peas, or any related plants or with a history of Quillaja bark-induced asthma. Avoid with aspirin or aspirin products or herbs or supplements with similar effects. Avoid with inflammation (swelling) or fever, stroke, transplants, or autoimmune diseases (like HIV/AIDS). Stop use two weeks before surgery/dental/diagnostic procedures with a risk of bleeding and avoid use immediately after these procedures. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders, or kidney disorders. Use cautiously with blood-thinners, blood sugar drugs, or diuretics or herbs and supplements with similar effects. Avoid if pregnant or breastfeeding.
• Bovine colostrum
  : Bovine colostrum has shown potential for immune stimulation. However, early evidence has not shown any benefit for reducing upper respiratory tract infection duration, although bovine colostrum may reduce symptoms. Further studies are required before a conclusion can be made.
• Avoid if allergic to dairy products. Use cautiously because toxic compounds, such as polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT), and dichlordiphenyldichloroethylene (DDE), have been found in human colostrum and breast milk. Thus, it is possible that these agents may be found in bovine colostrum. Avoid with, or if at risk for, cancer. Use cautiously with immune system disorders or atherosclerosis (hardening of the arteries). Use cautiously if taking medications, such as anti-diarrheal agents (e.g. Imodium®), insulin, or CNS agents (such as amphetamines, caffeine).
• Chiropractic
  : There is currently not enough reliable scientific evidence to conclude the effects of chiropractic techniques for respiratory tract infections. Additional study is needed in this area.
• Avoid with vertebrobasilar vascular insufficiency, aneurysms, arteritis (inflammation of the arteries), or unstable spondylolisthesis (a slippage of the vertebrae in the spine). Avoid use on post-surgical areas of para-spinal tissue. Use cautiously with acute arthritis, brittle bone disease, conditions that cause decreased bone mineralization, bleeding disorders, migraines, or if at risk of tumors or metastasis of the spine. Use extra caution during cervical adjustments.
• Eucalyptus oil
  : Despite widespread use in over-the-counter agents and vapors, there is not enough scientific evidence to recommend use of eucalyptus aromatherapy by mouth or inhaled, as a decongestant-expectorant for upper respiratory tract infections. The available studies have been poor quality, and have used combination therapies or 1,8-cineole (eucalyptol), which is a component of eucalyptus. Further study is needed.
• Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Use caution if driving or operating machinery. Avoid with a history of acute intermittent porphyria. Avoid if pregnant or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
• Garlic
  : Garlic (Allium sativum) may improve the immune system's ability to fight off infection, such as a cold virus, and may reduce the severity of upper respiratory tract infections. However, this has not been demonstrated in well-designed human studies.
• Caution is advised when taking garlic supplements, as adverse effects including an increase in bleeding and drug interactions are possible. Garlic supplements should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.
• Ginseng
  : Ginseng (CVT-E002) may be effective for preventing respiratory infections caused by the respiratory syncytial virus. More study is needed in this area.
• Caution is advised when taking ginseng supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Ginseng should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.
• Goldenseal
  : Goldenseal (Hydrastis canadensis) has become a popular treatment for the common cold and upper respiratory tract infections, and is often added to Echinacea in commercial herbal cold remedies. Animal and laboratory research suggests that the goldenseal component berberine has effects against bacteria and inflammation. However, due to the very small amount of berberine in most goldenseal preparations, it is unclear whether goldenseal contains enough berberine to have the same effects.
• Caution is advised when taking goldenseal supplements, as adverse effects including drug interactions are possible. Goldenseal supplements should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.
• Guided imagery
  : Therapeutic guided imagery may be used to help patients relax and focus on images associated with personal issues they are confronting. Experienced guided imagery practitioners may use an interactive, objective guiding style to encourage patients to find solutions to problems by exploring their existing inner resources. Biofeedback is sometimes used with imagery to enhance meditative relaxation. Interactive guided imagery groups, classes, workshops, and seminars are available, as well as books and audiotapes. Preliminary research in children suggests that stress management and relaxation with guided imagery may reduce the duration of symptoms due to upper respiratory tract infections, including colds. Additional research is needed to confirm these results.
• Guided imagery is usually intended to supplement medical care, not to replace it, and guided imagery should not be relied on as the sole therapy for a medical problem. Contact a qualified health care provider if mental or physical health is unstable or fragile. Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Use cautiously with physical symptoms that can be brought about by stress, anxiety, or emotional upset because imagery may trigger these symptoms. If feeling unusually anxious while practicing guided imagery, or with a history of trauma or abuse, speak with a qualified healthcare provider before practicing guided imagery.
• Licorice
  : Historically, licorice has been used for its expectorant and anti-tussive effects. The herbal combination product, KanJang®, has been studied for the treatment of uncomplicated upper respiratory tract infections. Results are mixed, and additional study is needed.
• Avoid licorice with a known allergy to licorice, any component of licorice, or any member of the Fabaceae (Leguminosae) plant family. Avoid licorice with congestive heart failure, coronary heart disease, kidney or liver disease, fluid retention, high blood pressure, hormonal abnormalities or if taking diuretics. Licorice can cause abnormally low testosterone levels in men or high prolactin or estrogen levels in women. This may make it difficult to become pregnant and may cause menstrual abnormalities.
• Moxibustion
  
  : Moxibustion is the application of heat to various
  points on the body. It is widely used traditionally in China for treatment of upper respiratory tract infections in children. However, at this time evidence is insufficient.
• Use cautiously over large blood vessels and thin or weak skin. Avoid with aneurysms, any kind of "heat syndrome," cardiac disease, convulsions or cramps, diabetic neuropathy, extreme fatigue and/or anemia, fever, inflammatory conditions, over allergic skin conditions or ulcerated sores, or skin adhesions. Avoid if pregnant or breastfeeding. Avoid areas with an inflamed organ, contraindicated acupuncture points, the face, genitals, head, inflamed areas in general, nipples, and skin adhesions. Avoid in patients who have just finished exercising or taking a hot bath or shower. Use cautiously with elderly people with large vessels. It is considered not advisable to bathe or shower for up to 24 hours after a moxibustion treatment.
• Thyme
  : Thyme has traditionally been used for the treatment of respiratory conditions including cough. The German Commission E (expert panel), has approved thyme for use in bronchitis. However, due to a lack of available data evaluating thyme alone (not in any combination products), additional study is needed to make a conclusion.
• Avoid with known allergy/hypersensitivity to members of the Lamiaceae (mint) family or to any component of thyme, or to rosemary (Rosmarinus officinalis). Avoid oral ingestion or non-diluted topical application of thyme oil due to potential toxicity. Avoid topical preparations in areas of skin breakdown or injury, or in atopic patients. Use cautiously in patients with gastrointestinal irritation or peptic ulcer disease. Use cautiously in patients with thyroid disorders. Avoid if pregnant or breastfeeding.
• Thymus extract
  : Preliminary evidence suggests that both intramuscular and oral thymus extract may be useful for reducing symptoms of respiratory tract infections. Additional study is needed in this area.
• Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid if receiving immunosuppressive therapy, with thymic tumors, myasthenia gravis (neuromuscular disorder), untreated hypothyroidism, or if taking hormonal therapy. Avoid if pregnant or breastfeeding; thymic extract increases human sperm motility and progression.
• Vitamin E
  : Daily supplementation with oral vitamin E may be beneficial for respiratory infection prevention. Additional research is warranted.
• Caution is advised when taking vitamin E supplements, as adverse effects and drug interactions are possible. Avoid if allergic or hypersensitive to vitamin E. Avoid with retinitis pigmentosa (loss of peripheral vision). Avoid if pregnant or breastfeeding, unless otherwise directed by a doctor. Use cautiously with bleeding disorders or if taking blood thinners.
• White horehound
  : Since ancient Egypt, white horehound (Marrubium vulgare) has been used as an expectorant (to facilitate removal of mucus from the lungs or throat). Ayurvedic, Native American and Australian Aboriginal medicines have traditionally used white horehound to treat respiratory (lung) conditions. The U.S. Food and Drug Administration (FDA) banned horehound from cough drops in 1989 due to insufficient evidence supporting its effectiveness. However, horehound is currently widely used in Europe, and can be found in European-made herbal cough remedies sold in the United States (for example, Ricola®).
• Avoid if allergic or hypersensitive to white horehound or any member of the Lamiaceae
  family (mint family). White horehound is generally considered safe when used to flavor foods. Use cautiously with diabetes, high/low/unstable blood pressure, high levels of sodium in the blood, irregular heartbeats or gastrointestinal diseases (like ileus, atony or obstruction). Use cautiously with diuretics (drugs that increase urine production). Avoid if pregnant or breastfeeding.
• Wild indigo
  : Preliminary evidence has shown immunostimulative properties in wild indigo extracts. However, available clinical studies have been conducted using the combination called Esberitox N (Echinaceae purpureae et pallidae radix, Baptisiae tinctoriae radix and Thujae occidentalis herba). Additional study is needed using wild indigo alone to better determine effectiveness for respiratory tract infections.
• Avoid if allergic or hypersensitive to wild indigo, its constituents, or members of the Fabaceae family. Use cautiously if taking immunosuppressive agents. Avoid if pregnant or breastfeeding.

D

Fair negative scientific evidence

• Echinacea
  : Initial research suggests that echinacea may not be helpful for upper respiratory tract infection treatment in children, possibly because parents are not able to recognize the onset of common cold symptoms soon enough to begin treatment, or because the dose of echinacea for use in children is not clear. There are fundamental differences in causes of upper respiratory tract infections in children versus adults (bacterial versus viral causes; different viruses; different sites of infection; etc). Until additional research is available, echinacea cannot be considered effective in children for the treatment of upper respiratory infections. Furthermore, development of rash has been associated with echinacea use, and therefore the risks may outweigh the potential benefits for children.
• Avoid if allergic to echinacea, its constituents, or any members of the Asteraceae/Compositae family (ragweed, chrysanthemums, marigolds, daisies). Use cautiously in patients prone to atopic reactions and in those with hemochromatosis and diabetes. Some natural medicine experts discourage the use of echinacea by people with conditions affecting the immune system, such as HIV/AIDS, some types of cancer, multiple sclerosis, tuberculosis, and rheumatologic diseases (such as rheumatoid arthritis or lupus). Use parenteral preparations of echinacea
  (no longer approved for use in Germany) cautiously. Use tinctures cautiously with alcoholic patients or in patients taking disulfiram or metronidazole. Avoid in patients presenting for anesthesia. Use cautiously if pregnant or breastfeeding.

• Experts believe that up to 80% of non-immunized family members will develop whooping cough if they live in the same house as someone who has the infection. For this reason, anyone who comes into close contact with an individual who has whooping cough should receive antibiotics to prevent spread of the disease. Young children who have not received all five doses of the vaccine may require a booster dose if exposed to an infected family member.
• Children: The best way to prevent whooping cough is with the pertussis vaccine, which doctors often give in combination with vaccines against two other serious diseases, diphtheria and tetanus. This three-in-one combination is known as the DTaP vaccine. It is a newer and safer version of the DTaP vaccine, which is no longer used in the United States. Doctors recommend beginning DTaP vaccination during infancy. The vaccine consists of a series of five shots, typically given in the arm and given to children at these ages: two months; four months; six months; 12-18 months; and four to six years. It takes at least three shots of the pertussis vaccine to fully protect a child against whooping cough, but a total of five shots are recommended by age six.
• Because immunity from the pertussis vaccine tends to wane by age 11, and because of the increase in cases of whooping cough in adolescents and teens between 11-18 years of age, doctors now recommend a booster shot for those in this age group (the tetanus, diphtheria and pertussis vaccine, or Tdap. DTaP is the name of the pediatric vaccine; Tdap is the name of the booster for people 11 years of age and older. The booster is given preferably at ages 11-12. This is in place of the traditional tetanus and diphtheria (Td) vaccine received at this age.
• Adults: The U.S. Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices also advises adults to receive a Tdap booster shot every ten years. The Tdap vaccine helps protect adults from pertussis and reduces the risk of them transmitting the infection to infants. Adults who are or will be in close contact with infants under 12 months of age should also receive the vaccine. Side effects of the vaccine may include fever, crankiness, vomiting, or soreness at the site of the injection. These problems are more likely to occur after the fourth or fifth dose of the DTaP series than after earlier doses. After late doses, some children may develop swelling of the arm or leg in which the shot was given. In rare cases, severe side effects may occur including: serious allergic reactions, in which hives or a rash develop within minutes of the injection; high fever, greater than 105 degrees Fahrenheit; and seizures, shock, or coma.
• Some individuals are concerned that the pertussis vaccine may cause neurological (nerve) damage because some children have developed brain damage after the immunizations. So far, however, researchers have not found a definitive link between the pertussis vaccine and brain damage. Still, research into this issue is ongoing. Children with known seizure or brain disorders may not be candidates for the DTaP vaccine.
• Other vaccines:
  In 2002, the U.S. Food and Drug Administration (FDA) approved a combination pertussis vaccine called Pediarix®. In addition to helping protect against pertussis, diphtheria, and tetanus, Pediarix® immunizes children against polio and hepatitis B (a serious viral liver infection). Because Pediarix® protects against five diseases, children need fewer shots. However, the vaccine also causes a wider range of side effects than does DTaP. In studies, the most common side effects of Pediarix® were pain, redness, and swelling where the shot was given, fever, and fussiness. A pediatrician will help individuals choose the best vaccination for their child.
• Scientists are studying the genome of Bordetella pertussis, the bacterium that causes whooping cough, in order to monitor its evolution and potentially find vaccine and drug targets specific to the new variations of the bacterium.
• Antibiotics: If a member of a household develops whooping cough, a doctor will likely prescribe antibiotics for the whole family to prevent spread of the infection to anyone else. Antibiotic treatment may also be prescribed for individuals and their families who have been exposed to B. pertussis in the workplace or in public.