Happy New Year! I, and I'm sure everyone else at Massage Today, hope that 2006 is full of joy, accomplishment and satisfaction for all of us. One way to achieve those goals is to keep healthy. On that note, let us turn to today's topic of discussion: whooping cough.

For most people born after 1950, whooping cough might sound like the stuff of 19^th-century fiction - the kind of disease you'd find in Little Women or Huckleberry Finn. Indeed, whooping cough was at one time a common childhood infection with the potential to be deadly. The development of an effective vaccine in the late 1940s has largely eradicated the sense of threat this condition once carried.

Several decades later, however, whooping cough is viewed as an emerging disease that carries some significant threats. The reasons for this are twofold. First, the childhood vaccines many of us had do not (as was once thought) impart lifelong immunity; in fact, they probably begin to wear off after about five years. Second, as the threat of childhood death from infections like mumps, rubella and scarlet fever has declined, the sense of importance of childhood vaccinations also has declined. Consequently, many children are not fully immunized.

Note: This is not the place to debate the efficacy, appropriateness or legitimacy of vaccines in general. Vaccinations are not a black-and-white issue. Some vaccines have higher efficacy and lower rates of complications than others (and vice-versa). Anyone who would like to debate this point will have to find another platform. That discussion is not my intention.

Whooping Cough: What Is it?

Whooping cough, also called pertussis, is a bacterial infection of the respiratory tract caused by a pathogen called bordetella pertussis. (Dog owners might recognize this name because a related bacterium causes "kennel cough," or bordetella.) About 10,000 people are diagnosed with whooping cough each year in this country (although some studies indicated it might largely be under-reported), and it causes about 10 deaths per year. The people most vulnerable to dangerously extreme infections are young children.

How Does it Work?

Whooping cough is highly communicable through airborne respiratory secretions, so a person with a bad cough easily can spread it to others. This bacterium invades the respiratory tract, killing ciliated cells and releasing toxins that stimulate a systemic immune reaction. The coughing that ensues has a characteristic presentation: the infected person expels so much breath that air rushes into the lungs with a "whoop" sound.

After a 7-10 day incubation period, whooping cough develops in three stages. The first stage is called the "catarrhal phase." At this point, it is indistinguishable from a common cold, and it lasts for several days. Instead of resolving, however, it proceeds to stage two: characteristic paroxysmal coughing, which occurs for up to 50 episodes a day and lasts 2-4 weeks. Coughing episodes are exhausting, and can be so taxing that they induce vomiting. The third stage is convalescence, which typically involves 3-4 weeks of recovery. A full course of whooping cough can cause even a fundamentally healthy person to lose 6-8 weeks of productivity and good health. Its effects on young children can be much worse.

Complications

The coughing pertussis causes is so severe that it can lead to bruised or broken ribs, abdominal or inguinal hernias, and vomiting. In young children, additional complications include under-nutrition (it's hard to eat when you're coughing so much it makes you throw up), pneumonia, anoxia, convulsions and even brain damage or death from lack of oxygen. Young children have the highest risk for the worst complications of pertussis; the rest of the population might experience severe infection, but are unlikely to have life-threatening complications.

Treatment Options

Treatment options for whooping cough present an interesting quandary. In its early stages, pertussis is indistinguishable from the common cold, and it's slow and expensive to culture. Any pediatrician might make a reasonable assumption that coughing, sneezing and mild fever are due to viral infection, and therefore not responsive to antibiotics. By the time a child has entered the severe coughing phase, antibiotics might no longer serve to shorten the duration or reduce the communicability of the infection. In short, the most efficient way to reduce the risks of pertussis in young children is to prevent the infection from developing, i.e., to be vaccinated.

Whooping Cough and Massage

Unless massage therapists work with young children, they are unlikely to see a client with the worst possible case of whooping cough. However, adolescents and young adults whose vaccinations have worn off are at risk for the infection, as are other people who come in contact with them. A client who has been diagnosed with this infection (or who has a family member with it) should wait until it has run its course before coming in close contact with other people. If a client has recovered from a pertussis infection, massage is, of course, safe and appropriate.

For Next Time

The floor is open. It will be early spring; crocuses will be poking up from a crust of snow. What disorders or diseases would you like to read about? One condition that's been generating a lot of attention lately is celiac disease, also called celiac sprue. While once considered rare, this gluten-sensitivity disorder is now considered by some researchers to be present in a low-grade form in about one out of every 33 people. Unless I hear otherwise, that's what I will pursue for March. If you have something else you'd like to discuss, let me know: what's on your table?

Until then, many thanks and many blessings.