No-one would deny that whooping cough is a distressing disease, especially for the littlest of babies.
Caused by the bacterial pathogen, Bordetella pertussis, or in a usually milder and often asymptomatic form, Bordetella parapertussis, whooping cough is a highly contagious, acute respiratory illness.
Around half of all babies under 12 months of age who contract whooping cough may require hospitalisation.
The mortality rate for babies under 6 months of age with whooping cough is 0.5%.
As the Centers For Disease Control and Prevention (CDC) confirms, once a person has had whooping cough, they'll have natural immunity for a long time – even up to 20 years. Some other sources say even longer.
However, babies under three months of age are most at risk.
Why Is Whooping Cough Such A Problem For Newborns?
Routine vaccinations are given at two, three and five months.
However, a newborn baby's immune system doesn’t respond well to vaccines at such an early age, because there is nothing there to stimulate.
It takes two or three doses of the whooping cough vaccine to be deemed effective, however, according to a World Health Organization (WHO) document, titled Vaccine Immunology:
On page 32, “Antibody responses elicited before 12 months of age rapidly wane and antibody titers soon return close to baseline levels.”
In addition, because the whooping cough vaccine efficacy rate is 70–80%, there's still a chance that after all doses are given, the vaccine recipient may continue to contract whooping cough.
The vaccine has also been wearing off much sooner than first thought, with fully vaccinated individuals being diagnosed well before they are due for a booster.
As a result, authorities are urging pregnant women to get vaccinated between 28-32 weeks of pregnancy, in an attempt to protect their babies after birth.
What isn't mentioned is the DTaP (diphtheria, tetanus, pertussis) vaccine is a class C drug, meaning risk cannot be ruled out. According to the drugs.com website: “There are no controlled data in human pregnancy. Diphtheria/pertussis, acellular/tetanus is only recommended for use during pregnancy when benefit outweighs risk”.
The Boostrix vaccine (for those above 10 years of age) information says: “Animal reproduction studies have not been conducted with Boostrix. It is also not known whether Boostrix can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Boostrix should be given to a pregnant woman only if clearly needed.”
Unfortunately, even vaccinated individuals may be unknowingly spreading pertussis. Two Pubmed study references can be found here and here. “This investigation highlights the need to maintain awareness, particularly amongst staff working with neonates [newborns], that pertussis infection can arise despite complete vaccination.”
Read more about reasons why we're really having whooping cough outbreaks. Hint: it's probably not what you've been led to believe.
Speaking about vaccine refusal in an article on WebMD, infant immunisation expert Romina Libster, MD said, “It's hard to say how big a contributing factor this is. In a recent outbreak in California, most of the children who got whooping cough were immunized.”
So what can you do to help from home?
Read on to find out what you need to know about whooping cough symptoms, and how you can best support your baby's immune system.
Whooping Cough Symptoms
The incubation period of whooping cough tends to fall between 6-20 days, but is most commonly around 14 days.
According to the CDC, early whooping cough symptoms in the first one to two weeks are similar to a cold, and include:
- Runny nose
- Mild cough
- Low-grade fever – tends to remain this way throughout
- A pause in breathing (apnea) in infants
Some cases of whooping cough may involve no fever.
As whooping cough progresses, the symptoms begin to develop into the classic whooping cough signs, including:
- Coughing fits followed by gasps for air, creating the high pitched ‘whoop’ sound
- Exhaustion after the coughing fits
The coughing fits may continue for around 10 weeks or more (whooping cough is also referred to as 100-day cough, due to it lasting around that long), and may be more common at night. Generally as the disease progresses, the cough gets worse.
While there is no instant cure for whooping cough, here are four important things for pregnant women and their partners to know:
#1: Breastfeeding Is Important
Babies under six months of age are most vulnerable to whooping cough.
In Australia, by just two months of age, 50% of babies are partially or fully formula fed, which is a significant number. Peak health organisations around the world recommend exclusive breastfeeding until six months of age (then for breastfeeding to continue, alongside with the introduction of solids, ideally iron rich foods first). The number of babies reaching this goal in Australia is around 14%, with other countries sporting similar rates.
While breastmilk can’t prevent or cure whooping cough, it certainly goes a long way. Breastfeeding helps your baby to have a stronger immune system, so he can better fight disease.
Full of anti-infective factors, every teaspoon of breastmilk contains around 3,000,000 germ-killing cells. Every drop counts. Read our article here on how to give yourself the best chances at breastfeeding success, as well as our must read article about what's in breastmilk.
#2: Normal Birth Is Important
Currently, around one in three babies in Australia and the US are born by c-section.
Based on extensive research, the World Health Organization advises c-section rates beyond 10-15% do not help to save extra lives, and therefore, may be unnecessary. Professionals and parents alike are concerned about the huge gap between the recommended rate of c-sections and the actual rate.
But why is normal birth important?
A baby born vaginally will come into contact with his mother’s vaginal flora, which is very important for his immune system and defense. Find out more about how to give your baby’s immune system the best start, and if you need a c-section, have a read about vaginal seeding.
#3: Your Diet – Before And After Baby – Is Important
What you eat influences your gut bacteria and your breastmilk.
Research has found breastmilk from obese mothers usually contained a different and less diverse bacterial community, compared with breastmilk from normal-weight mothers.
Your baby will get so much more than nutrients from your breast milk. He or she will also receive valuable prebiotics and probiotics, as well as a host of important immune protective factors.
By having more beneficial bacteria in your gut, you could pass on more beneficial bacteria (probiotics) to your baby through your breast milk.
To support the growth of diverse, healthy gut bacteria, make sure your diet includes plenty of leafy greens and fresh fruit and vegetables, in an array of colours. Eliminate processed sugars (including sugary drinks and juices) and processed grains from your diet. Both are inflammatory to the body and can cause disease. Not only can they impact the wellbeing of your immune system, but they can mess with your hormones, as well as hijack your overall health status.
An experienced naturopath can supply a quality, practitioner strength pre and probiotic for pregnancy, after the birth, and even for your baby. Some parents also swear by sodium ascorbate to help ease the severity of coughing fits, which you might like to discuss with a naturopath. Read Doctor Suzanne Humphries' article about vitamin C and whooping cough.
Again, doing these three things may not prevent you or your baby from getting whooping cough, however an immune system in the best shape possible is much better than one that's not.
#4: Hibernating After The Birth Is Important
The babymoon period is a very important time that you’ll never get back. It’s a critical time for attachment and bonding. You’re also getting the hang of being a parent, and hopefully on the path to breastfeeding working well. Privacy and hibernation is important in this period.
Having everyone around you vaccinated — termed cocooning — does not seem to be effective in protecting your baby, according to research. It's the reason why the previous Australian government stopped the free vaccination program for families, stating they had been advised by experts that it's not effective enough to continue. Even the CDC have admitted while experts recommended cocooning a decade ago, it wasn't effective enough, because anyone can give a baby whooping cough. Only 44% of the time could the source of the whooping cough be identified.
Especially considering we're amidst a whooping cough outbreak, it's a good idea to limit guests and visitors in the post-birth period. For those who do come and visit, make sure they’ll respect your wishes for hand washing and hygiene, as well as staying away if they have even a mild cough or cold. Avoid passing around your baby too – babywearing may help prevent excited hands reaching out for a cuddle.
If you're pregnant, you may even like to consider a homebirth if you’re low risk, so you can give birth away from patients and sick people. Homebirth is a safe option for low risk women – a study of 150,000 births in the Netherlands was published in the British Medical Journal. They found outcomes were better for low risk women who birthed with midwives. Other studies have uncovered similar findings. For more information, visit Homebirth Australia.
Here are 15 things to avoid when visiting a new baby – pop it on Facebook or other social media you use, and let everyone know what you agree with.
Don't forget to read our other reasons why hibernating after the birth is so important.
A Contentious Subject
While it’s easy to get heated over a serious disease and point the finger of blame during times of outbreak, remember, whooping cough is cyclical in nature. Every three or four years, there tends to be an outbreak. Even in countries with high vaccine coverage, unfortunately outbreaks are common. It's the nature of the beast.
In 2014, the state of New South Wales recorded around 140 cases of whooping cough per month. In January 2015, the amount had risen, closer to 500 per month. During the peak of the previous outbreak of 2010-2011, Dr Vicky Sheppeard, Director of Communicable Disease at NSW Health said there were closer to 2,000 cases per month.
In comparison, according to the Australian Bureau of Statistics, in 1988 there were 153 cases of whooping cough in Australia, and we didn't have a 95% vaccination rate.
Science continues to work on finding the most effective and safe vaccination possible, in order to help prevent deaths from whooping cough. But there are some major hurdles they need to overcome.
Reports of pertussis mutating (dropping a protein, which the vaccine targets), as well as changes to the vaccination are being cited as possible reasons for the heightened outbreaks. “One school of thought says the introduction of a new vaccine in 2004 has been a factor in the rising rates of whooping cough.”
Studies have reported, “Our data suggests that the current schedule of acellular pertussis vaccine doses is insufficient to prevent outbreaks of pertussis.”
In the year 2000, acellular vaccines for Bordetella pertussis began to replace whole cell vaccines in many countries, such as Australia, the United States and the United Kingdom. More outbreaks began.
In addition, a study in 2013 found vaccinated baboons were protected from severe symptoms, but could carry the whooping cough bacteria in their throats for around 6 weeks. What does this mean for vacinated humans? The researchers concluded:
“These data provide a plausible explanation for pertussis resurgence and suggest that attaining herd immunity will require the development of improved vaccination strategies that prevent B. pertussis colonization and transmission.”
Something also to consider is those who have access to very young babies. Recently in Melbourne, a Maternal Health Care Nurse was suffering from a case of undiagnosed pertussis, after having already worked with mothers and babies. Also, some visitors to NICUs have reported not being questioned about their whooping cough status.
One mother confided, “I know upwards of eight people whose doctors wouldn't swab for whooping cough because they'd had boosters, and couldn't possibly have the disease. Two more weeks of spreading their germs before a proper diagnosis.”
So while science works on fixing the gaps, all we can do is focus on our own health and wellbeing as best as possible.
For more research and an indepth (but easy to read) explanation of why we're seeing more outbreaks, see our article here.
No matter if you decide to vaccinate during pregnancy or not (it's a personal decision only you can make), the best way to protect yourself and your baby is by ensuring you follow a healthy lifestyle as possible and hibernating in the early weeks as best you can. Aim for a healthy birth and baby-led breastfeeding journey. By doing so, you’ll give your baby’s immune system a fighting chance.