The paroxysmal stage occurs after 10 to 14 days when the cough becomes daily and increases in severity. Five to 15 or more rapidly consecutive, forceful coughs occur during a single expiration, and are followed by the whoop.

When I began my practice in 1950, the most important injection I gave to infants was called DTP – diphtheria, tetanus and pertussis (whooping cough). This vaccine controlled these three diseases very well, and I rarely saw any of them among my young patients. Now, whooping cough is making a comeback. Down to barely 1,000 cases in 1976, pertussis steadily rose in the U.S. in the ‘80s and ‘90s. Then in 2002, it jumped to 9,771 cases and in 2003 the number climbed to 11,647. Preliminary numbers for last year showed the cases reached an alarming 19,000, with a predicted 37,000 cases this year.

Scientists say the disease is infecting adolescents whose childhood vaccinations are wearing off, so this spring, federal health officials were expected to approve and then recommend a new booster shot for young teenagers. "Pertussis is a substantial public health problem in the U.S.," said Karen Broder, a Center for Disease Control and Prevention Medical Epidemiologist, specializing in infectious childhood diseases.

The heartland is being hit hardest: Kansas, Indiana, Wisconsin, Iowa, North Dakota and Ohio have all seen large numbers of whooping cough cases. The disease can be fatal to infants less than six months old, and health officials worry that the rise of pertussis around babies makes them more susceptible before they start to get shots at two months old. From 1979 to 2002, 128 people died from whooping cough, 117 of whom were less than a year old.

The major problem is that unlike other childhood diseases that have vaccines, pertussis shots seem to wear off after about five years. Unlike many other diseases, a person can get whooping cough more than once. Pertussis is an acute, highly contagious bacterial disease characterized by a spasmodic cough that usually ends in a prolonged, high pitched, crowing inspiration (the whoop). Transmission is by breathing in the B. pertussis, a small, nonmotile bacillus, which is sprayed into the air when the patient sneezes or coughs.

Patients usually are not infectious after the third week of coughing. The incubation period averages seven to 14 days. The pertussis bacteria invade the mucosa of the nose, throat, trachea, and bronchi. The uncomplicated disease lasts about six to 10 weeks, and consists of three stages: catarrhal, which begins with cold-like symptoms of sneezing, tearing, loss of appetite, restlessness, and hacking night coughs. Fever is rare. The paroxysmal stage occurs after 10 to 14 days when the cough becomes daily and increases in severity. Five to 15 or more rapidly consecutive, forceful coughs

occur during a single expiration, and are followed by the whoop. In infants, choking spells may be more common than whoops. The convalescent stage usually begins within four weeks. The coughs are less frequent and less severe. Average duration of illness is about seven weeks. Patients should be quarantined, particularly from susceptible infants for at least four weeks or until symptoms have subsided. Hospitalization is recommended for seriously ill infants. Suction to remove excess mucous from the throat may be life saving. And don’t forget to pray.