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Fast Fact

Pertussis is commonly known as whooping 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.
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.

see Fast Facts about Pertussis »

Recognizing Sexual Abuse

10.20.2001 Add new comment Send to friend Print this article

How can I recognize sexual abuse if it happened to my three-and-a-half-year-old daughter? About a month ago she told me a friend of ours touched her vagina. Since that time she has said nothing else and on gentle questioning she said it did not happen. There are no behavioral changes and her behavior towards the man in question has not changed at all. They've always had great times together. I have no idea why she said this and my feeling is that it is completely innocent. She is also at the stage where she is very interested in what a penis is and what a vagina is - she occasionally can be found on the floor probing her vagina. But, is there anything I should be concerned about and how do I recognize real abuse of a child?

Palo Alto, California

Some of the most poignant episodes of my pediatric training were long visits with children victimized by sexual abuse. I vividly remember sitting with tears streaming down my face after hearing how children had been scarred by those they trusted.

How sad that we need to be discussing this subject for a three-and-a-half-year-old! Unfortunately, there is no age at which a child is exempt from sexual abuse. About one third of cases occur in kids younger than six years of age, about one third in children ages six to twelve, and one third in children ages twelve to eighteen.

Sexual abuse includes any activity with a child for the sexual gratification of an adult or significantly older child (more than about 4 years older). Children's intense need for affection and nurturance from older figures makes them vulnerable. Adults and older children hold a position of tremendous power in their lives. It is the abuse of this power, and the abuse of children's trust, that is so damaging.

Sexual abuse falls into three different categories:

molestation, which is defined as the touching or fondling of the genitals of a child, or asking a child to touch or fondle an adult's genitals, or using a child to enhance pleasure from sexual acts or pornography;
sexual intercourse, which includes vaginal, oral, or rectal penetration;
rape.

Most abuse begins with innocent physical contact. A needy adult then makes this a routine. Once a routine is developed, it is not uncommon to progress to intercourse.

The most common perpetrator of sexual abuse is either a family member or a close friend of the family. Sexual abuse by a stranger is quite uncommon.

Sexual abuse commonly comes to light through the child's disclosing the incident of sexual contact to a trusted adult. Historically, a child's word was not taken seriously. Over the last twenty years the pendulum swung to the opposite extreme; if a child described sexual contact it was considered a fact, and the volunteering of such information was considered very strong legal evidence. Recently, the pendulum has returned to a more balanced position: take it very seriously whenever a child mentions sexual contact, but understand that not everything said necessarily mirrors physical reality.

The best way to clarify a situation such as you have described is to have your child examined by a sexual abuse specialist in. Most children's hospitals have a sexual abuse team, or will be able to refer you to a specialist in your area. (The two hospitals that offer this service in your area are Santa Clara Valley Medical Center in San Jose and the Keller Center at San Mateo Medical Center.)

A sexual abuse examination is comprised of two basic elements. First, and perhaps most important, your daughter would be interviewed by an expert who very gently elicits information from her about what might have happened. Efforts are made to minimize the number of times a child has to tell the story and the number of people visibly present during the interview. The interviewer will let your daughter set the pace and will use pictures or dolls to draw her out, without suggesting to her what might have occurred.

This is generally followed by a physical examination of the external genitals, checking for any sign of trauma, laxity, or discharge. Sometimes this will be done with magnification, using an instrument called a colposcope.