Dr. Greene, I was wondering if you could be so kind to answer my question regarding whooping cough. I am a mother of 5-year-old twins. The twins were born 2 months premature. At a few months old they had their first DPT shot.
They both experienced side effects when administered. Both of them cried & screamed for several hours, had a rash where the shot was given & had high fevers of around 104.
I called the Doctor to tell her what was going on. She told me that they were reacting to the "P" part of the DPT shot. Since then they have not been given the "P" part of the DPT immunization.
I am very concerned about my kids. Currently there is an epidemic in California where young children have died from this disease. Please tell me whatever you can about pertussis.
Being that my children are now 5 years old in your opinion can my children pickup the "P" part of DPT now? What are the actual side effects of this immunization?
Your response is greatly appreciated.

I stood outside the closed door of the hospital room where an adorable 6-week-old baby lay all alone in her crib. As I scrubbed my hands in the sink outside the isolation room, an electronic monitor allowed me to hear her breathing peacefully.

Suddenly the quiet was shattered by a fit of coughing. And she couldn't stop. The coughs came so closely together that she couldn't catch her breath. I grabbed a mask from above the sink and, pressing it over my face, entered her room. The coughing continued. The pulse and oxygen monitor at her bedside complained insistently that her blood-oxygen levels were dropping too. The EKG monitor sounded an alarm that her heart rate was dropping. And she continued to cough. Even before I reached her bedside I could see that her face was turning blue. She began to vomit.

Moments later the peace had returned. Her various monitors beeped tranquilly; the coughing spasm was over. This little girl with pertussis survived, but she had many more weeks of coughing spasms before she could return home to her parents.

Pertussis, or whooping cough, which once ravaged children around the world, is again on the rise. Worldwide, about 300,000 people die from pertussis each year. Global travel can result in outbreaks anywhere. Earlier this month, all pediatricians in my area received a public health alert about a sudden, dangerous increase in pertussis cases.

On the other end of the pertussis spectrum, I saw a healthy 12-year-old boy in my office this week. He had had a nagging cough for the last month. Sometimes he hacked up mucus with his cough. Sometimes the cough came in fits. Once or twice he had coughed until he vomited. Otherwise he felt pretty well -- he just couldn't seem to shake the cough.

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. As you might guess, it can be far worse in people with asthma or with immune deficiencies.

People with pertussis go through four stages:

1. Incubation. For 5 to 21 days after exposure (usually 7 to 10 days) there are no symptoms at all while the bacteria multiply.
2. 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.
3. 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.
4. Convalescence.
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