Whooping cough can be fatal in young infants, experts warn

Pertussis, or whooping cough, is on the rise and incidence now exceeds pre-pandemic numbers. While in adults and older children the cough can be bothersome and last for months, pertussis in young infants can be life-threatening. Most children under 2 months of age with pertussis in the United States are hospitalized.

In a special article published in Pediatrics, experts strongly encourage vaccination, especially during pregnancy.

“Pertussis symptoms are different in infants,” said leading author Caitlin Li, MD, infectious diseases specialist at Ann & Robert H. Lurie Children’s Hospital of Chicago and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine.

“The characteristic whooping cough may be absent, but apnea, or breathing interruption, is common.”

Pertussis in infants can also present with very high white blood cell count (“leukocytosis”), which pediatricians might mistake for cancer or other noninfectious conditions. Extremely high white blood cell counts in infants should prompt strong consideration of pertussis, according to the authors.

“Given that infants are at high risk for complications, pertussis vaccination of mothers during pregnancy is critical, as it protects newborns against this potentially fatal illness,” stressed Dr. Li. “Widespread vaccination is also an important tool to protect everyone.”

The Centers for Disease Control and Prevention (CDC) currently recommends vaccine doses at 2, 4, 6, 15–18 months and 4–6 years of age. A booster dose is recommended at 11–12 years, with catch-up at 18 years. The CDC also recommends universal vaccination during pregnancy, optimally between 27–36 weeks of gestation, as the primary tool to prevent pertussis-related deaths.

Rapid initiation of antibiotics is recommended for all patients with confirmed or suspected pertussis. If given early in the disease course, this therapy may improve symptoms. While later treatment is unlikely to impact symptoms, it does reduce transmission.