Whooping Cough – Epidemiology and Treatment
What is Whooping Cough?
Whooping cough, also known as Pertussis, is a highly contagious acute respiratory disease, caused by a bacteria called Bordetella pertussis. Whooping cough tends to be more prevalent in children towards late primary school. However, younger children and adults can also be susceptible. The disease is most serious for children under the age of one year, when it has a higher chance of being life threatening.
Whooping cough begins with a catarrhal stage, just like a cold, that goes on for 10 to 12 days. The initial mild cough becomes progressively irritating and finally paroxysmal. The infection descends from the upper respiratory system along the mucosal surfaces of the larynx, trachea and the bronchial tree. Excessive mucous production may plug the lower airways. This is what causes the paroxysmal coughing, which is characterized by a series of struggling coughs and ending with an involuntary ‘whoop’ of inspiration at the end. Not all cases will have the ‘whoop’. The mucous is very tenacious and difficult to expel.
The paroxysmal stage may remain acute for two to three weeks and persist for one or two months.
Whooping Cough is diagnosed by a nasal swab. Blood tests are also usually taken to check the white blood cell count. It is possible, however, for tests to come back negative and still have Pertussis. Whooping Cough in Australia is a notifiable disease. GPs are obliged to inform the department of health when they have diagnosed a case.
Incubation and Infectious Period
Infection is transmitted by droplet spread of respiratory secretions or by indirectly by contamination of objects in the environment, including hands and tissues.
Incubation is usually 7 to 10 days after exposure. People are most infectious in the late stages of the incubation period and during the catarrhal stage. Family members are considered still at risk until the paroxysmal stage begins to subside. As a general rule, the person is infectious from day 7 after exposure to the end of the 3rd week of the paroxysmal stage. Or, until completing the prescribed course of antibiotics.
GPs routinely prescribe antibiotics for Whooping Cough – usually Erythromycin or Ampicillin. However, there is a general understanding that this does not resolve the cough in many cases. Morello, JA et al tell us that
“Antibiotic therapy is not markedly effective but may help to modify the most severe symptoms, prevent secondary pulmonary infection and shorten the communicable period; they may reduce the severity of the disease, but they do not change its course to any marked degree. “(1984:355/356)
It is thought that when antibiotics are taken at the very early stages of infection, it may prevent the disease from descending into the lower respiratory tract. This may prevent the disease from entering the 100 day cough phase. GPs generally advise that after taking antibiotics for 5 days, you are no longer infectious. However, you most likely will still have the cough.
Hospitalisation may be necessary for severe cases or young infants to monitor breathing and ensure that airways remain open. Should a respiratory emergency occur, there are excellent medical interventions to hand in this environment.
Morello, JA et al states that “The most effective control of…infection is by specific immunity actively acquired through the natural route of infection or by artificial immunization programs. Active immunity acquired during an attack of the disease in childhood is durable, but occasional second attacks occur in exposed adults.” (1984:356/357)
Dr Sheppeard, the director of communicable diseases at NSW Health, tells us that "Whooping cough is a bit different to the other bugs we deal with…Whether you have the disease, the infection, or whether you get vaccinated that immunity starts to wear off after a few years. Every few years the number of people in the community that are susceptible to infection that don't have immunity build up to large numbers allowing outbreaks to occur."
From looking at both of these perspectives, it is possible that immunity may have greater longevity when the disease has been contracted live and antibodies develop naturally.
Control of Infection
If you suspect a family member may have whooping cough, take them to a GP for testing. Being vaccinated does not guarantee immunity. If possible, keep the person separated from people who may be at risk, at least until the contagious period has passed. Take particular care to avoid being near babies and infants. Outside play may be preferable to being in confined spaces with siblings.
Take appropriate precautions to help prevent the spread of infection to vulnerable people, such as young infants. Pay attention to hygiene, hand washing and disposal of contaminated tissues. Encourage children to cough into their arm instead of hands, which may transfer infection to toys and surfaces. At home, clean the sick area and disinfect when necessary. Take care to separate eating utensils and wash with very hot water.
Look after yourself when unwell. Take time out to rest, eat nutritious food and keep hydrated. This will support your body and it’s immune system to fight the infection and will help speed up recovery. Also keep your children home with you when they are unwell. Resist the temptation to dose them up with medication so that they can ‘soldier on’. This will only prolong the illness and make them feel miserable. If your children are unwell for an extended period of time, get family members to help with the caring, particularly the night shift so that you don’t become exhausted.
There are many natural healthcare options that can help boost the immune system and treat uncomfortable symptoms associated with whooping cough. Here are some things that you can try at home.
For a wet cough, drink three to four cups of hot ginger tea a day. To make this, boil 3 slices of fresh ginger in 2 cups of water for 15 minutes.
Hot water with freshly squeezed lemon juice and a little honey helps reduce mucous.
Gargle with warm salt water.
Drink licorice root tea, one cup 3 times a day as an expectorant.
Avoid dairy products, sweets and heavy foods.
Drink one to three glasses a day of fresh juice that includes carrot.
Homeopathy and Whooping CoughIndications for Selected Homœopathic Medicines
Homœopathy has a good track record for relieving the symptoms and discomfort of coughs, including whooping cough and croup. For whooping cough, it is recommended that you seek help from a registered homœopath and remember to always seek medical advice in emergencies.
As with any homœopathic treatment, it is essential to administer the medicine most similar to the symptoms in each person. 10 people with whooping cough may all need a different medicine, according to their individual symptom picture. If there is no change after three doses, then the medicine is not correct.
Antimoniumtartaricum (Ant t)
There is much rattling of mucus in the chest without much expectoration. Breathing is rapid, short and difficult and the lips may be blue and the person will have overpowering sleepiness. The child Antimoniumtartaricum will be irritable and cross and will cry when approached. The tongue will be white. There may be diarrhoea with great debility. Vomiting shortly after midnight. There is marked aggravation form warmth and warm drinks; worse for lying down. Feels better getting the mucous out, burping or vomiting. Better sitting up and in the cold, open air.
Belladonna is indicated at the early inflammatory stage of whooping cough, when symptoms come on suddenly, violently and with the characteristic fever, heat and redness. It is indicated for sudden violent paroxysms of whooping cough, without any expectoration. They may have nose bleeds from coughing and the patient is worse at night. Another indication for belladonna is the attacks terminate by sneezing. This is an unusual symptom, so would be a strong indication. The cough is excited by a tickling in the throat, as if from far down. Retching and vomiting and pain in the stomach are prominent symptoms. The person may feel scared, grasp their throat and cling to their mother.
Coccus cacti (Cocc c)
Paroxysms of coughing with vomiting of clear, ropy, tenacious mucous extending in long strings. The paroxysms come on in the morning.
Choking cough with thick, stringy mucous; racking cough leading to vomiting.
Accumulation of thick, stringy mucous in the nose and throat; profuse nasal discharge; feels like there is a thread hanging down the back of the throat. The excess mucous is marked and causes a strangling and choking sensation.
Worse for heat, exposure to cold and lying down.
Better for cold air, cold drinks and bathing in cold water.
Desire for large quantities of water frequently.
Is a useful medicine for the protracted bronchial catarrhs remaining after whooping cough.
Corallium rubrum (Cor r)
This is a very useful remedy in severe cases of whooping cough. Before the cough there is a smothering sensation, which is in the form of gasping, crowing inspirations. The child gasps and becomes black in the face. It is a remedy for that shot, quick, ringing cough. After each attack of cough the person sinks back completely exhausted. No other homœopathic medicine produces such a violent paroxysm. It is more often indicated in the later stages of the affection, but the constriction of the chest before the attacks must be present. The crowing inspiration of whoop is not so pronounced as under Mephitis.
Cuprum metallicum (Cupr)
Cuprum is a remedy where symptoms are characterised by spasm.
It may be needed after Drosera has done its work if spasm becomes the key feature.
Cuprum is useful for whooping cough when the paroxysms are long, uninterrupted and spasmodic. The cough is very violent and the person feels as they are going to suffocate. The person coughs up tough, gelatinous mucous. There is rattling in the chest and the face and lips are bluish.
There is relief from sips of cold water.
One of the most commonly prescribed medicines for whooping cough, but more indicated for uncomplicated cases.
Violent fits of hard coughing with choking. Can barely breathe while coughing.
Dry, barking, croupy, spasmodic cough that ends in gagging or vomiting.
Every attempt to cough up the mucous ends in vomiting.
Cough can be triggered by a sensation of dryness and irritation in the larynx, as if a crumb there. May have nosebleed from the cough.
Painful cough with deep, hoarse voice.
Worse for lying down in be; worse at night and after midnight.
Worse for getting warm in be and worse for cold food or drink.
The child cries a great deal.
Heparsulph (Hep s)
Whooping cough with a croupy of barking cough that is worse from the slightest exposure to cold air or drafts. There is tightness in the chest and rattling but the thick, yellow mucous in the lungs is very difficult to expectorate. People needing Heparsulph are extremely irritable and annoyed by everything and hypersensitive to their environment, including pain and cold. They feel better for heat and wrapping up and are worse in the evening until midnight.
Is indicated for whooping cough where there is great nausea and the person feels short relief after vomiting. The cough is gagging and convulsive and the person stiffness out and becomes blue or pale and loses its breath. The discharge of mucus is copious and tenacious and very difficult to bring up. Violent shattering coughs following each other in quick succession, not permitting recovery of breath. The person is limp and weak, and there is free perspiration.
They feel better in the cool, fresh air. Cough is worse for becoming warm, eating or drinking and lying down.
Kali bichromicum. (Kali bic)
For whooping cough where there is spasmodic, hacking, deep-sounding, croupy cough with coryza and difficulty in getting the breath. This remedy suits cases where there is a hoarse cough and the person breathes superficially and rapidly to prevent attacks of coughing. People feel worse from eating and on inspiring deeply; there is a general catarrhal involvement of the nose, throat and frontal sinus, and the expectoration is yellow, tough and stringy, differing from that of Coccus cacti in being yellow.
Mephitis putorius (Meph)
Mephitis is useful in a cough with a well marked laryngeal spasm, a whoop. Cough is worse at night on lying down, there is a suffocated feeling, and the child cannot exhale. The catarrhal symptoms calling Mephitis are slight, but the whoop is prominent. The smothering comes on with cough, while with Corallium rubrum it comes on before the cough, and is followed by great exhaustion. There is not much expectoration with Mephitis. There are many spasmodic symptoms with this remedy, such as cramping of the legs at night. It is a remedy that is especially suitable to whooping cough in adults.
“Homœoprophylaxis is the use of potentized substances in a systematic manner to prevent the development of the charachteristic symptoms of infectious diseases.” Isaac Golden (2012:2)
Samuel Hahnemann, the founder of homœopathy, discovered that the Homœopathic medicines used to treat epidemic disease could also help prevent contracting the disease. Dr Isaac Golden has spent his life researching and studying this topic. In his book, The Complete Practitioner’s Manual of Homœoprophylaxis, he outlines the origins of thinking around use of homœopathic medicines for epidemic disease prevention and therapeutic guidelines.
For epidemic diseases such as whooping cough, Isaac asserts that
“The Genus Epidemicus (GE) remedy, that is the remedy most commonly needed to treat the active disease, will provide prophylaxis in most cases during an outbreak provided it is well chosen. However, if the GE remedy is unclear, as is frequently the case in the very early states of every outbreak, then the nosode will offer a significant level of protection errespective of which GE remedy eventually emerges from the accumulated case histories.”
Nosodes are homœopathic medicines made from substances secreted in the course of a disease, used in the treatment of that disease. As with all homœopathic medicines, they undergo a series of dilution an succussion and are free from contagion.
The nosode and the GE remedy are both chosen according to homœopathic principles.
The nosode for whooping cough is Pertussin.
The GE remedy for whooping cough is Drosera or Coccus cacti.
Guidelines for HP During a Whooping Cough Epidemic.
Fortnightly doses of Drosera or Coccus cacti 200c.
Or Pertussin 1M.
If the likelihood of exposure is high, and the disease is virulent, then Isaac recommends a weekly dose for 2 - 3 weeks, then fortnightly.
You need to consult with a homœopath to discuss HP and the guidelines for epidemic prescribing.
Several years ago, my family had whooping cough. 2 out of 4 of us tested positive to Pertussis via a nasal swab, but it is my belief that we all had the disease. I believe this because my daughter, who had tested negative, was the only one who developed the ‘whoop’. She was the first one to contract pertussis. By the time she was tested, it is possible that the organism was no longer in her nasal secretions. She was not prescribed antibiotics as her test was negative. It was also past the stage where antibiotics were likely to have helped.
One of the reasons she was not tested earlier, was because the GP did not consider her presentation as being consistent with whooping cough, despite my being concerned about her high risk. This is an important point to note: symptoms can vary considerably between individual presentations of pertussis.
The rest of us had coughs to varying degrees. My two sons took the prescribed antibiotics at the onset of symptoms. Their cough did not develop and they recovered fairly quickly, with the help of homœopathic medicines.
What was apparent to me, was that the antibiotics may have rendered us non-infectious, but homœopathy cured the cough. Witnessing my daughter being unable to breathe after the paroxysmal cough stands out clearly in my mind to this day. She would have been in her early teens. I was aware that after each coughing attack her airway would spasm, so when she went to inhale, her airway was closed. It was this that appeared to make the whooping noise – her attempt to get air through a very narrow space. She became extremely panicked, which escalated the breathing difficulty. I had to reassure her and help her to calm down.
After consideration, I prescribed the homœopathic medicine Cuprum. As soon as the Cuprum drops entered her mouth, the spasm released and she could breathe. Each time her cough ended in such a spasm, she was given a dose. To my surprise, after three doses the cough loosened and the spasm did not return. This is a medicine that I have prescribed for other cases, where there has been such spasm accompanying the cough and each time the medicine has brought relief.
I love homeopathy!
Golden, Dr I. (2012) The Complete Practitioner’s Manual of Homœoprophylaxis. Isaac Golden Publications. Victoria.
Morello, JA, Mizer, HE, Wilson, ME (1984) 4th Ed. Microbiology in Patient Care. Macmillan Publishing, USA.
Reichenberg-Ullman, J & Ullman, R. (1997) Homeopathic Self-Care. Prima Publishing, USA.
Valman, Dr B (1997) Children’s Medical Guide. The AMA and NZMA. Dorling Kindersley Publishing, Australia.