Pertussis is caused by bacteria that attach themselves to the cilia (little hairs) that line the respiratory tract. These bacteria produce a potent toxin that inflames the respiratory tract and that prevents the cilia from functioning properly.
The disease can be serious or fatal in infants and unimmunized children. It is much milder in teens, adults, and in immunized children - but still can be a real nuisance.
People with pertussis go through four stages:
Incubation. For 5 to 21 days after exposure (usually 7 to 10 days) there are no symptoms at all while the bacteria multiply.
Prodrome. For the next 1 to 2 weeks, pertussis is not unlike a cold. People have runny noses, sneezing, and perhaps a low-grade fever. A mild cough begins that gradually worsens.
Paroxysms. The worst part of the illness lasts from 1 to 6 weeks. Spasms or attacks of coughing may come up to 15 times per day. Sometimes, especially in children, the cough is followed by a "whoop" noise as they breathe in rapidly, attempting to get air. Even so, young infants will often turn blue with the spells from lack of oxygen. The mucus is often thick and sticky. Gagging, choking, and vomiting are common. Sometimes young infants will stop breathing for varying lengths of time. This stage of pertussis is much milder in adults, teens, older children, and immunized children.
Convalescence. As if this disease were not already long enough, the cough continues for another 2 to 4 weeks, but gradually becomes less severe and less frequent. Even after the cough seems finally over, the spasms often recur briefly for the next several months - especially during colds and during exertion.
Current lab tests to detect pertussis are either slow, cumbersome, not readily available, or often fail to pick up the disease.
According to the Centers for Disease Control and Prevention people are considered to have pertussis if they have a cough lasting for at least 14 days (with no other confirmed cause) and any one of the following symptoms (even if they have been immunized): Coughing spasms or fits (coughs comes in clusters), a whooping noise while breathing in, or vomiting caused by the cough.
The case is called confirmed pertussis if there is a positive lab test or if there has been exposure to someone with a positive lab test.
During a pertussis outbreak, anyone who has a cough lasting at least 14 days (with no other known cause) probably has pertussis, even in the absence of other specific symptoms.
Pertussis is treated with an antibiotic (Biaxin, erythromycin, Septra, or Zithromax). The antibiotic doesn't much affect the length of the illness, but is very effective at stopping its spread.
People with pertussis are highly contagious for up to 5 days after starting the antibiotic.
You or your child have been exposed if you spend a total of 5 hours in the same room with someone with the disease (over a week), or if you sit next to someone with pertussis for any length of time, or if you have any contact at all with infected mucus or saliva.
Between 70 and 100 percent of susceptible people will catch pertussis if they are exposed.
Currently, most adults and teens are susceptible because the protective effect of their childhood pertussis immunizations has waned. To address this problem, it is now recommended that all teens receive a booster vaccine at 11-18 years of age (preferably between 11-12 years).
Between 60 and 80 percent of infants are protected after the first 3 doses of vaccine, but this protection begins to disappear when they are toddlers. After the 4th immunization at 18 months old, 80 percent are protected for the next 3 to 4 years. The 5th dose, at kindergarten entry, protects them for another few years. A booster dose is recommended during the teen years to bolster immunity to pertussis.
People who have been exposed to probable or confirmed pertussis should either receive a course of preventative antibiotics (and I say this as someone strongly opposed to the overuse of antibiotics), or be kept home from daycare, school, or work for at least 3 weeks. If the exposed individual develops symptoms, they should receive antibiotics to prevent further spread of pertussis to others.
Children under age 7 who have been exposed should receive a pertussis vaccine, unless they have already had 4 doses of pertussis vaccine (and the last dose within 3 years), or unless there is a compelling reason not to immunize them. Exposed teens 11-18 years old who have not already received a booster vaccine should receive one.
With all that we know about tobacco, how can people still smoke? Easy. They're enticed by big business; they enjoy it; it's cool; and it's very, very habit forming. Now for the shock--poor nutritional choices cause every bit as much cancer, death, disability, and chronic disease as cigarettes do. The modern American diet is public health threat number one (American Journal of Preventive Medicine, March-April 1995). With all that we know about junk food, how can people still eat it? Easy. They're enticed by big business; they enjoy it; it's cool; and it's very, very habit forming.
When I was growing up, my father grew tomatoes in our backyard. These vine-ripened tomatoes were absolutely delicious--far better than any others I can remember having. As plants grow, the new growth is built from materials taken from the soil. Nothing can be incorporated into plants unless it is present in the soil. Plants grown in depleted soils are just not the same. Commercial fertilizers can put the basic required minerals back into the ground, but this simplified soil is not as rich as organically maintained soil. Plants do the best they can with whatever materials are available.
When my daughter was born, she weighed 7 pounds, 6 ounces. Today, as I write, she is 8 years old and weighs over 50 pounds. All of the materials for this dramatic increase in size have come from the food she has eaten. Like the tomato plant, Claire's body does the best it can with available materials.
When I look at my children playing football in the park, I am looking at structures built from the food they have eaten, the composition depending on the nutrients that were available at the time. When you begin to really see this, you begin to feel differently about hot dogs...
Getting children to eat well is far easier said than done. For the next 5 days--the first full week of the New Year--I'll give you some tips for making delicious and healthy changes. We'll start today with the foundation principle. This won't solve the challenges by itself, but without this principle, other tips won't work well in the long run.
Sometime around 9 months of age, many babies begin to think that smooshed baby foods are not where it's at. They develop an intense desire to eat whatever it is that you are eating. This is a critical part of child development because your child will begin to strongly imprint your health patterns. Eating junk food while offering our children vegetables just doesn't work.
I can remember the brave little face of my son. Daddy was drinking a cup of coffee. My boy kept asking for a sip. I declined by saying that it tastes yucky to kids and making a face. He persisted, and I gave him a little sip. His face combined shock, disgust, and disappointment. His eyes got big and watered. Then he smiled and said, "More." It reminded me of the time I smoked a cigar offered to me by an older boy on a scouting trip. Kids' desire to imitate at this stage is a deep, powerful force. Tap into it.
Many of us have unhealthy habits that we've accumulated over the years. The miracle of having a child is often our best opportunity to shed those habits that don't serve us and to develop new ones that do. Our parenting instincts make it easier to do something for our children that we would not do for ourselves alone. These changes, of course, directly benefit our children as they follow our examples. They also benefit our children by giving them healthy, energetic parents, both now and in the years to come. They add freshness to our marriages or adult relationships. And of course, they are what our own bodies are crying out for.
So when your child begins wanting food from your plate, let it be fresh fruits and vegetables plus whole grains. When he or she wants to taste what you are drinking, let it be something you would be happy for your child to drink. Don't let your baby's foray into the world of adult foods be potato chips, French fries, or sugary treats.
Of course, budding toddlers will want some foods that you don't eat. They won't take all the ones that you do. Still, don't miss out on the power of imitation to make healthy eating habits natural for your child. And remember, we can't give something that we don't have.
When you give children good nutrition, you are giving them the nutrient building blocks that literally become the eyes you look into; the knees that get scraped; the bones that support their growing bodies; their inquisitive, curious brains; and the hearts that pump quietly night and day down through the years.
Most of the treatments for poison ivy, oak and sumac are aimed at reducing the itching, until the self-limited rash runs its course, which takes about two weeks. Click here for Dr. Greene’s tips on treating these allergic reactions.
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