Whooping cough: symptoms, testing and treatment by video in Puerto Rico

Whooping cough (pertussis) is a respiratory illness caused by the bacterium *Bordetella pertussis*. The CDC says it is found only in humans and spreads easily from person to person through the air when someone who is sick coughs or sneezes. It spreads more when people spend a lot of time together and share breathing space, as at home.

Many people have mild symptoms and do not know they are infected, which is why many babies catch it from an older sibling, a parent or a caregiver. A person can spread it from the start of symptoms and for at least two weeks after the cough begins.

According to the CDC, symptoms usually start 5 to 10 days after exposure, but can take up to 3 weeks. The illness moves through three stages:

1. Cold-like stage (1 to 2 weeks). It looks like a common cold: a runny or stuffy nose, a low fever (under 100.4 °F) and a mild cough that gets worse.

2. Coughing-fit stage. One to two weeks after the first symptoms, coughing fits begin: many rapid coughs in a row, then a long breath in with a high-pitched "whoop." Vomiting and exhaustion can follow a fit. Fits are often worse at night and disturb sleep. They usually last 1 to 6 weeks and can last up to 10.

3. Recovery stage. The cough eases slowly over 2 to 3 weeks. Fits can come back months later with another cold.

Whooping cough in adults. In teens, adults and vaccinated people the illness is often milder and the whoop is often missing: sometimes there is only a persistent cough that will not go away for weeks. That is why it is easy to miss, and why an adult can pass it to a baby without knowing.

Babies under 1 year old are at the highest risk. The CDC says many babies barely cough: instead they may have pauses in breathing (apnea), turn blue or struggle to breathe. Some seem to have only a cold.

About 1 in 3 babies under 1 year old with whooping cough needs care in the hospital. Among hospitalized babies, the most common complications are apnea and pneumonia; seizures and brain damage can also happen, and about 1 in 100 die. If your baby has a cough, pauses in breathing or turns blue, go to the ER or call [911](tel:911).

You see Dr. Diana Nieves Castro, MD, a general practice physician licensed in Puerto Rico (check her license), with several years of emergency-department experience. We see adults and children of all ages, in English or Spanish; patients under 21 have a parent or legal guardian on camera.

In the visit, the doctor asks how the cough started, how long you have been coughing, whether anyone at home has a cough and which vaccines you have had, and watches you cough and breathe on camera. If she suspects whooping cough, she gives you a lab order for a PCR test at a lab near you. If appropriate, she prescribes an antibiotic and we send your prescription to your pharmacy, even before the result when your history points to it.

A doctor's note for work or school is included if you need one. Video doctor visits 24/7. Book your visit.

Whooping cough is confirmed with a swab from the back of the nose (a nasopharyngeal swab) for a PCR test. The CDC says PCR works best in the first 3 weeks of cough; after the fourth week the amount of bacteria drops and the risk of a false negative rises. That is a good reason to get seen early if your cough is not going away.

After 2 weeks of cough, a blood test (serology) can help in some cases. The doctor tells you which test fits and gives you the order.

Whooping cough is treated with antibiotics. The CDC recommends macrolides, such as azithromycin, as the first choice. According to the CDC, starting an antibiotic early may shorten the time you are contagious and, in the first 1 to 2 weeks, make symptoms less severe. Started later, it no longer changes the course of the cough or prevents spread.

The CDC recommends treating people 1 year and older within 3 weeks of cough onset, and babies under 1 within 6 weeks. The doctor decides whether treatment is appropriate for you and, if it is, prescribes.

At home: drink plenty of fluids and eat small meals every few hours to help prevent vomiting after coughing. Cough medicines do not relieve the fits. The American Academy of Pediatrics recommends children stay home from child care or school until they have finished 5 days of antibiotics.

The CDC recommends a preventive antibiotic (postexposure prophylaxis) for everyone who lives in the home of a person with whooping cough, even if they are vaccinated and have no symptoms, within 21 days of when that person's cough began. It is also recommended for people at high risk of severe illness, such as babies under 1 year or people with a weakened immune system or moderate to severe asthma, and for people who are or soon will be in contact with them, such as women in the third trimester of pregnancy.

The doctor can evaluate each person in the home by video and, if appropriate, prescribe the preventive antibiotic. Each person needs their own visit, and anyone under 21 has a parent or guardian on camera.

Vaccination is the best way to prevent whooping cough. Children get DTaP at 2, 4 and 6 months, at 12 to 18 months and at 4 or 5 years, then a Tdap booster at 11 or 12. Adults who never had it can get it, especially if they will be around a baby. The CDC recommends Tdap during every pregnancy, between weeks 27 and 36, to pass protection to the baby.

We do not give vaccines. You can get vaccinated at your doctor's office, at pharmacies, at community health centers and at the Puerto Rico Department of Health. Also: cover your cough, wash your hands often and keep babies away from anyone who is coughing.

For your safety, call 911 or go to the emergency room if you see any of these signs. More in when to go to the ER.

• A baby under 12 months with a cough and possible whooping cough (coughing fits, vomiting after coughing or someone at home with whooping cough)
• Pauses in breathing (apnea)
• Blue or gray lips, face or skin
• Trouble breathing
• Seizures
• Signs of dehydration: can't keep fluids down, vomits everything or pees very little