Be Aware of the Potential Risks of Pertussis Infection. Whooping cough, Knowing the Enemy. The 100-day Cough. Part II

Pertussis, also known as whooping cough, now commonly called 'The 100-day cough," is a highly contagious bacterial infection that significantly impacts the respiratory system. Even with vaccines widely available, pertussis remains a serious public health issue. Outbreaks continue to occur in various parts of the globe, stressing the importance of awareness about this infection. In this post, we will explore the risks, symptoms, and preventive measures associated with pertussis.

What is Pertussis?

Pertussis is caused by the Bordetella pertussis bacterium, which leads to severe coughing fits lasting several weeks. The initial symptoms are mild and often resemble those of a common cold, making it tough to recognize at first. As the infection advances, the cough intensifies and is frequently accompanied by a characteristic “whooping” sound during inhalation.

The infection spreads primarily through respiratory droplets from coughing or sneezing. While pertussis can affect anyone, it poses particular risks to infants who may not yet be fully vaccinated.

Recognizing the Symptoms

Identifying the symptoms of pertussis early is essential for appropriate treatment. The infection typically evolves through three stages:

1. Catarrhal Stage: Lasting one to two weeks, this stage causes symptoms similar to a cold, including a runny nose, mild cough, and sneezing.

2. Paroxysmal Stage: Following the catarrhal stage, the cough escalates, becoming violent and lasting weeks or even months. The cough is often punctuated by the distinctive "whoop" sound upon inhalation.

   
   

3. Convalescent Stage: This final stage indicates the beginning of recovery, with coughing gradually declining over weeks or months.

   
   

Recognizing these stages allows for timely medical attention, which can lessen the severity of the disease.

The Hidden Dangers of Pertussis

Although many individuals recover, pertussis can lead to severe complications, particularly for vulnerable groups.

Complications in Infants

Infants, especially those younger than one year, face a heightened risk of serious complications due to their still-developing immune systems. Hospitalization rates for infants can reach up to 50% in severe cases. Complications include:

• Pneumonia: This is the most common serious complication, which may require hospitalization in severe instances.

• Seizures: Intense coughing can lead to oxygen deprivation, triggering seizures.

  
  

• Cerebral Hypoxia: Serious coughing fits can deprive the brain of oxygen, resulting in potential brain damage.

  
  

Complications in Older Children and Adults

Older children and adults may experience complications, though less frequently. Examples include:

• Weight Loss: The severity of the cough can lead to difficulty in eating or drinking, potentially resulting in weight loss and dehydration.

  
  

• Rib Fractures: Intense coughing spells can cause rib injuries, especially in older adults.

  
  

• Urinary Incontinence: Severe coughing can inadvertently result in loss of bladder control in some individuals, particularly women.

  
  

These complications emphasize the critical need for vaccination and increased awareness to prevent the spread of this infection.

Rare Complications of Pertussis

Pertussis (whooping cough) can cause several rare but serious complications, especially in infants, young children, and individuals with underlying health conditions. These complications can arise from the intense coughing episodes or as a result of the systemic effects of the infection. Here are some rare complications:

Neurological Complications

1. Seizures

   • Result from hypoxia due to prolonged coughing fits or fever.

2. Encephalopathy (Pertussis Encephalopathy)

   • Rare but serious complication, possibly related to hypoxia or toxins, leading to altered mental status, developmental regression, or long-term cognitive impairment.

Respiratory Complications

3. Pulmonary Hypertension

   • Secondary to hypoxia or infection-induced inflammation.

4. Pneumothorax

   • Caused by the rupture of alveoli due to high intrathoracic pressures during forceful coughing.

5. Subcutaneous Emphysema

   • Air leakage into subcutaneous tissues, particularly around the neck and chest, due to excessive coughing.

6. Bronchiectasis

   • Chronic inflammation can lead to permanent structural damage to the airways, resulting in recurrent infections and impaired lung function.

Cardiovascular Complications

7. Cardiac Arrest

   • Extremely rare, often secondary to severe hypoxia or acidosis in infants.

8. Myocarditis

   • Rare inflammation of the heart muscle, possibly related to systemic effects of the infection.

Gastrointestinal Complications

9. Rectal Prolapse

   • Caused by increased abdominal pressure during violent coughing spells.

Skeletal Complications

10. Cough-induced Fractures

    • Rib fractures in adults and older children due to intense coughing fits.

Immunological and Systemic Complications

11. Secondary Bacterial Infections

    • Such as pneumonia caused by opportunistic pathogens like Staphylococcus aureus or Streptococcus pneumoniae.

12. Malnutrition and Dehydration

    • Prolonged illness and feeding difficulties in infants can lead to weight loss and electrolyte imbalances.

13. Hemorrhages

    • Intracranial, subconjunctival, or nasal hemorrhages caused by increased vascular pressure during coughing.

Perinatal and Pregnancy Complications

14. Preterm Labor

    • Severe coughing can induce uterine contractions in pregnant women.

15. Intrauterine Growth Restriction (IUGR)

    • Rarely, severe maternal pertussis may affect fetal growth due to hypoxia.

These complications highlight the importance of early diagnosis, vaccination, and prompt treatment of pertussis to prevent severe outcomes.

The Importance of Vaccination

Vaccination is the most effective way to prevent pertussis. The DTaP vaccine is recommended for children, along with booster shots (Tdap) for adolescents and adults. Vaccination not only protects individuals but also helps reduce the risk of outbreaks in the community, thereby safeguarding everyone.

Despite the known benefits, vaccine hesitancy presents challenges. In a 2019 survey, approximately 18% of parents expressed concerns about vaccine safety, which can delay immunization efforts and prolong the cycle of infection. Education campaigns are vital in dispelling myths and promoting high vaccination rates, ultimately shielding vulnerable populations.

Final Thoughts

The hidden dangers of pertussis emphasize the need for awareness, prompt diagnosis, and vaccination. Understanding the symptoms, potential complications, and preventive measures empowers individuals and communities to effectively combat this preventable disease.

Ongoing public health initiatives, along with community education, are crucial for creating a safer environment, particularly for those most at risk, such as infants and individuals with weakened immune systems. By recognizing the risks associated with pertussis and committing to preventive strategies, we can take important steps toward safeguarding collective health and well-being.

Setting of a vaccination clinic promoting immunization against whooping cough.

Each person's contribution is vital in ensuring that we avoid the serious consequences of pertussis in our communities. Let us unite in the effort to keep ourselves and each other safe.

References:

• Zatovkaňuková, P., & Slíva, J. (2024). The potential dangers of whooping cough: a case of rib fracture and pneumothorax. BMC Infectious Diseases, 24, Article number: 1293.

  • This case report discusses a 48-year-old woman who developed a cough-induced rib fracture and recurrent pneumothorax due to pertussis, highlighting severe complications in adults.

    BMC Infectious Diseases

• Gopal, D. P., Barber, J., & Toeg, D. (2019). Pertussis (whooping cough). The BMJ, 364, l401.

  • This article reviews the management of pertussis, emphasizing its mimicry of viral upper respiratory infections and the importance of considering it in differential diagnoses.

    BMJ

• Demirhan, S., & Ogle, M. (2024). Pertussis (Whooping Cough). Pediatric Care Online, American Academy of Pediatrics.

  • This reference outlines the clinical presentation of pertussis in infants, noting complications such as pneumonia, apnea, cyanosis, pulmonary hypertension, seizures, encephalopathy, and death.

    AAP Publications

• Scarpino, S. V., & Dimitrov, N. B. (2015). Asymptomatic transmission and the resurgence of Bordetella pertussis. BMC Medicine, 13, 146.

  • This study explores the role of asymptomatic transmission in the resurgence of pertussis, discussing its implications for public health and infection control.

    BMC Medicine

• Cherry, J. D. (2015). Pertussis: challenges today and for the future. Pediatric Annals, 44(9), e218-e222.

  • This article discusses the resurgence of pertussis, challenges in diagnosis, and the need for improved vaccines to address waning immunity.

• Klein, N. P., Bartlett, J., Rowhani-Rahbar, A., Fireman, B., & Baxter, R. (2012). Waning protection after fifth dose of acellular pertussis vaccine in children. The New England Journal of Medicine, 367(11), 1012-1019.

  • This study examines the decline in vaccine-induced immunity over time, contributing to increased susceptibility to pertussis in later childhood.

• Mooi, F. R., van Loo, I. H., & King, A. J. (2001). Adaptation of Bordetella pertussis to vaccination: a cause for its reemergence? Emerging Infectious Diseases, 7(3 Suppl), 526-528.

  • This research explores how genetic changes in B. pertussis may contribute to its resurgence despite vaccination efforts.

• Winter, K., Glaser, C., Watt, J., & Harriman, K. (2014). Pertussis epidemic—California, 2014. Morbidity and Mortality Weekly Report, 63(48), 1129-1132.

  • This report provides data on a significant pertussis outbreak, discussing factors contributing to its spread and public health responses.

• Clark, T. A. (2014). Changing pertussis epidemiology: everything old is new again. The Journal of Infectious Diseases, 209(7), 978-981.

  • This article reviews shifts in pertussis epidemiology, including increased incidence in certain age groups and potential reasons for these changes.

• Wendelboe, A. M., Van Rie, A., Salmaso, S., & Englund, J. A. (2005). Duration of immunity against pertussis after natural infection or vaccination. The Pediatric Infectious Disease Journal, 24(5 Suppl), S58-S61.

  • This study compares the duration of immunity following natural infection versus vaccination, with implications for booster vaccination strategies.

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David S. Klein, MD FACA FACPM

David S. Klein, MD, FACA, FACPM

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Tel: 407-679-3337

Fax: 407-678-7246

www.suffernomore.com

David S. Klein, MD Functional Medicine Physician

Neck Pain due to a common, yet underdiagnosed problem: Levator Scapulae Syndrome

Are you one of the many people who struggle with neck and shoulder pain? You’re not alone. These complaints are frequent across various age groups and lifestyles. One often overlooked cause of these discomforts is nerve entrapment near the levator scapulae muscle and the scapula. This post explores the causes, symptoms, and management of nerve entrapment in this area, offering practical insights for those experiencing chronic neck and shoulder pain.

Understanding the Anatomy

Tendinitis at this point causes pain in the shoulder, neck and may radiate to the pectoral muscles; referred pain to the thumb, index and middle fingers.

The levator scapulae muscle is positioned at the back and side of the neck, connecting the cervical vertebrae to the upper border of the scapula. Its main job is to stabilize and elevate the shoulder blade, which helps with neck movement. However, if nerves around this muscle become compressed or entrapped, significant pain and discomfort can result.

The Levator Scapulae Muscle is important in posture but is delicate and easily injured.

The brachial plexus, a network of nerves communicating between the spine and the arm, passes close to the levator scapulae. If inflammation occurs in this area, the brachial plexus may become irritated, resulting in pain that radiates from the neck into the shoulder and down the arm. Statistics show that approximately 75% of people will experience some form of neck pain in their lifetime, with a significant percentage attributing it to nerve-related issues.

Skeletal anatomy showing levator scapulae muscle location.

Causes of Nerve Entrapment

Nerve entrapment at the levator scapulae can result from several factors, including:

1. Poor Posture: Slouching or maintaining a forward head posture while sitting at a desk can chronically strain the levator scapulae. Research indicates that 80% of office workers may exhibit neck pain due to poor posture, leading to nerve compression over time.

   
   

2. Repetitive Strain: Engaging in repetitive activities like lifting, overhead reaching, or long hours of computer use can create muscle tension and inflammation. In a study, 60% of individuals in labor-intensive jobs reported neck pain related to repetitive strain.

   
   

3. Stress and Tension: Mental stress doesn't just affect moods; it tightens muscles, increasing the risk of nerve entrapment. Studies show that stress-related muscle tension can significantly increase neck pain symptoms.

   
   

4. Injury: Whiplash or other neck injuries can alter muscle balance and positioning, contributing to nerve compression. Data suggests that about 50% of individuals with whiplash report persistent neck pain months after the injury. The Levator Scapulae can be injured with slip and fall accidents, lifting injuries and with general 'wear and tear-repetitive use situations.'

   
   

5. Degenerative Conditions: Conditions like osteoarthritis can result in bone spurs, which can further compress nerves. In older adults, degenerative changes can be a leading cause of nerve-related neck pain.

   
   

Understanding these causes is crucial for finding effective treatment and prevention strategies.

The pain is often worse with rotation to the opposite side

Symptoms to Watch For

Identifying the symptoms of nerve entrapment in the levator scapulae area is essential for timely intervention. Common symptoms include:

• Localized Pain: Sharp or dull pain localizing in the neck and upper shoulder region.

• Radiating Pain: Discomfort that travels down the arm, potentially into the shoulder.

• Numbness or Tingling: A tingling sensation in the arm or hand, indicating nerve compression.

• Muscle Weakness: Difficulty raising the arm or gripping objects due to muscle weakness linked to nerve irritation.

  
  

If any of these symptoms persist for more than a week, consulting a healthcare provider is wise. Early diagnosis can prevent further complications and enhance recovery.

Therapeutic massage combined with oral anti-inflammatories, muscle relaxants and nerve blocks are often used, in conjunction. This problem is benign, non-life or limb threatening, but it is truly, a pain in the neck.

Diagnosis and Treatment Options

To diagnose nerve entrapment, healthcare providers will conduct a comprehensive medical history and physical examination. Techniques such as MRI or ultrasound may be employed to evaluate the structures near the levator scapulae.

Once diagnosed, effective treatment options include:

1. Physical Therapy: A qualified physical therapist can design a personalized exercise program to strengthen and stretch neck and shoulder muscles. Studies indicate that physical therapy can reduce neck pain by up to 60%.

   
   

2. Chiropractic Care: Spinal adjustments can help restore alignment and alleviate nerve pressure. Many patients report significant pain relief after chiropractic treatment.

   
   

3. Massage Therapy: Therapeutic massage can reduce muscle tension and promote relaxation in the affected area. Research shows that around 70% of patients experience relief from chronic neck pain following regular massage.

   
   

4. Pain Management: Anti-inflammatory medications or corticosteroid injections may temporarily relieve pain and swelling. An estimated 30 to 90% of those suffering from neck pain find relief through these medications, and injections often provide immediate relief.

   
   

5. Home Care: Utilizing heat or cold packs, along with gentle stretching exercises at home, may assist in symptom management.

   
   

6. Topical Medications: The use of topical anti-inflammatories can provide substantial and nearly immediate relief of pain, if properly applied to the attachment of the Levator at the tip of the Scapula.

   
   

   There are any number of topical medicines, prescription and non-prescriptions, available.

   My two favorites are topical MSM, marketed by our practice, nation-wide, as "Kink-Ease," and the widely available topical diclofenac "Voltaren." My preference for the use of Kink-Ease is based on the lower cost per treatment, value per dosage, but also on the fact that it was invented/developed by me.

   
   

   I use Voltaren with patients and recommend it many times daily, but while it can be used effectively as a sole agent, it works much better when alternated with the Kink-Ease lotion.

   
   

   

   Voltarin topical diclofenac is now OTC available.

   
   

   

   Kink-Ease MSM Cream 16 oz. $44.95/bottle Three for $114.62

   
   
   
   
   
   

Recognizing the appropriate interventions is key to alleviating pain and restoring function.

Preventative Measures

Preventing nerve entrapment requires attention to posture and lifestyle habits. Here are some strategies to consider:

• Maintain Proper Posture: Ensure your sitting and standing positions support a neutral spine. Ergonomically designed office equipment can greatly enhance posture.

• Incorporate Regular Exercise: Engage in activities that promote flexibility and strength in the neck and shoulders, reducing tension and future pain episodes.

• Take Frequent Breaks: For those in desk jobs, taking regular breaks to stand, move around, and stretch can combat muscle tightness. A break every hour can significantly reduce discomfort.

• Manage Stress: Use relaxation techniques such as yoga, meditation, or deep breathing exercises to lessen muscle tension and anxiety.

  
  

Implementing these preventative measures can significantly decrease the likelihood of encountering neck and shoulder pain in the future.

Taking Action on Your Health

Neck and shoulder pain caused by nerve entrapment at the levator scapulae muscle and scapula is a common but often undiagnosed issue. By understanding the anatomy, recognizing the symptoms, and exploring effective treatment options, individuals can take charge of their health. Increasing awareness and proactive management can improve quality of life, reducing the impact of pain on daily activities. If you are grappling with these symptoms, consult a healthcare professional to discuss your diagnosis and potential care options.

REFERENCES:

• Physiopedia. (n.d.). Levator scapulae syndrome. https://www.physio-pedia.com/Levator_Scapulae_Syndrome

  
  

• OrthoFixar. (n.d.). Overview of levator scapulae pain causes and treatment. https://orthofixar.com/for-patient/levator-scapulae-pain-treatment

  
  

• Release Muscle Therapy. (n.d.). Levator scapulae pain: Unraveling the mystery and finding relief. https://releasemuscletherapy.com/pain-in-levator-scapulae-relief

  
  

• Leagrave Therapy. (n.d.). Neck pain and levator scapulae syndrome. https://www.leagravetherapy.co.uk/levator-scapulae-syndrome-and-neck-pain

  
  

• Physiopedia. (n.d.). Levator scapulae. https://www.physio-pedia.com/Levator_Scapulae

  
  

• Physio.co.uk. (n.d.). Levator scapulae syndrome. https://www.physio.co.uk/what-we-treat/musculoskeletal/conditions/shoulder/levator-scapulae-syndrome.php

  
  

• Bel Marra Health. (n.d.). How is levator scapulae pain related to stiff neck and how to relieve the pain?. https://www.belmarrahealth.com/levator-scapulae-pain-causes-symptoms-treatment-exercises

  
  

• Physical Therapy. (n.d.). Levator scapulae muscle pain: Cause, treatment, exercise. https://physical-therapy.us/levator-scapulae-muscle-pain

  
  

• Physio Insights. (n.d.). Levator scapulae pain. https://physioinsights.com/2020/12/31/levator-scapulae-pain

  
  

• NSMI. (n.d.). Levator scapulae syndrome - Muscular injuries. https://www.nsmi.org.uk/articles/muscular-injuries/levator-scapulae-syndrome.html

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David S. Klein, MD FACA FACPM

David S. Klein, MD, FACA, FACPM

1917 Boothe Circle, Suite 171

Longwood, Florida 32750

Tel: 407-679-3337

Fax: 407-678-7246

www.suffernomore.com

David S. Klein, MD Functional Medicine Physician

Unveiling the Looming Threat: Understanding the Surge of Pertussis Infections and Preparing for the Next Potential Pandemic. Whooping cough: The 100 day cough.

Whooping Cough, Pertussis, "The 100 day cough," and "Kennel Cough"

Making a deadly come-back: Pertussis, Whooping Cough, also known as "The 100 day Cough"

Pertussis, commonly known as whooping cough, is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis. In the wake of recent global health challenges, health officials are increasingly concerned about a potential resurgence of this infection. With its alarming rise in cases, understanding pertussis and how to combat it is more important than ever.

It can result in rapid death in young children, protracted illness and death in the immunocompromised and elderly, and it is an easily treated infection.

The Rise of Pertussis: A Historical Perspective

Pertussis, whooping cough, now called the 100 day cough, has been around for centuries, with significant outbreaks documented even before vaccines were introduced. The widespread use of the pertussis vaccine in the 1940s dramatically reduced its prevalence. Unfortunately, in recent years, vaccination coverage has dipped. In 2019, more than 15,000 pertussis cases were reported in the United States alone, a number that was significantly higher than previous years. This resurgence especially affects infants and young children, who are at the highest risk for severe complications.

Why the Recent Surge?

. T

Several factors contribute to the recent increase in pertussis infections Those pesky inoculations (shots) only give immunity for 5 to 7 years.

Declining Vaccination Rates

One major reason for the rise in cases is the decline in vaccination rates. For instance, a 2021 study found that vaccination coverage among children dropped to 84%, down from 94% in previous years. Misinformation about vaccines and limited healthcare access contribute to this troubling trend. When a significant number of individuals within a community are unvaccinated, the risk of outbreaks increases, as seen in 2018 when several states in the U.S. experienced localized outbreaks.

Mutation of the Bacteria

Research indicates that Bordetella pertussis may be mutating, leading to new strains that might evade vaccine-induced immunity. A study published in 2020 indicated that recent strains could potentially increase the risk of infection among vaccinated individuals. This raises questions about the long-term effectiveness of current vaccines and highlights the need for vaccine updates.

Increased Awareness and Reporting

Heightened vigilance surrounding respiratory infections since COVID-19 could also explain the surge in reported cases. Healthcare providers are now more likely to recognize and diagnose pertussis. In the past year, many hospitals reported a 30% increase in the diagnosis of pertussis-related cases compared to before the pandemic.

Whooping Cough can be deadly, particularly in infants and elderly

Symptoms and Complications of Pertussis

Recognizing the symptoms of pertussis is key for early diagnosis and effective treatment.

Early Symptoms

Initially, pertussis may present with mild symptoms that resemble a cold, like a runny nose and slight cough. This can lead to misdiagnosis. In recent times, early detection has become increasingly crucial, as each week of delay can lead to worsening symptoms.

Paroxysmal Cough

After one to two weeks, patients often experience severe, uncontrollable coughing fits that characterize pertussis. These coughing spells can lead to vomiting or even broken ribs in extreme cases. A study indicated that up to 50% of patients experience complications so severe they require hospitalization.

Risks for Infants

Infants, particularly those under one year old, are at the highest risk for serious complications from pertussis. In 2017, approximately 90% of pertussis-related deaths occurred in infants in the U.S., underscoring the critical need for timely vaccination and awareness.

So, Just when you thought you have all bases covered....... You can catch pertussis from your Dog, as 'Kennel Cough.'

Yes, you can catch this from your pets.

Preventative Measures and Vaccination

Prevention is pivotal in addressing the rise of pertussis infections. Get the DPT vaccine every 5 to 7 years.

Vaccination Strategies

Health professionals advocate for comprehensive vaccination strategies. This includes administering the DTP (Diphtheria, Tetanus, Pertussis) vaccine during childhood and a Tdap booster for older children and adults. Ensuring that individuals receive these vaccinations is essential for maintaining herd immunity. Data shows that maintaining an 80% vaccination rate can help prevent widespread outbreaks.

Public Awareness Campaigns

Raising awareness about the importance of vaccinations is crucial. Public health campaigns should focus on countering misinformation, providing clear data about vaccine safety and effectiveness, and encouraging vaccinations for all age groups. For example, community workshops can engage parents and correct misconceptions, potentially increasing local vaccination rates.

The Role of Healthcare Providers

Healthcare providers can significantly impact the fight against pertussis infections.

Diagnosing and Reporting

Healthcare professionals need to be vigilant in diagnosing pertussis, especially in patients with severe coughing who are unvaccinated or have known exposure. Implementing rapid tests and accurate reporting systems can help manage and reduce outbreaks effectively.

Counseling Patients

Doctors should proactively discuss vaccination benefits with their patients. Educating families about the importance of maintaining vaccination schedules and addressing myths is key to fostering compliance and awareness. A study indicated that where discussions about vaccines occurred routinely, vaccination rates increased by 25%.

Preparing for the Future

As concerns about pertussis continue to grow, preparedness becomes increasingly crucial. Understanding factors behind the rise in infections will enable public health officials and communities to respond effectively.

Everyone plays a role in building herd immunity, staying informed, and promoting vaccination efforts. By working together, we can address the challenges posed by infectious diseases like pertussis. An informed community is one of the best defenses against future health crises.

Adopting proactive measures today will pave the way for a healthier tomorrow. Staying informed and following public health guidelines will remain our best strategy against emerging infections.

Clinical notes from the Doc:

1. Diagnosis is Key: Ask your physician for a Respiratory Panel PCR that includes Pertussis.

2. Use your resources. Get the DPT shot.

3. NAC and Guaifenesin are helpful to loosen up the thick, miserable secretions that can persist with this infection.

4. Drink more water than you ever did. It helps loosen the secretions.

5. Antibiotics most useful to treat:

   1. Erythromycin (EES is a good one, 400 mg taken three times daily for 3 weeks

   2. Sulfamethoxazole (Septra DS) taken twice daily for 14 days

   3. You will be tempted to try a Z- pack, but repeated regimens, that is, you will most likely need multiple prescriptions of the z-pak to make it work.

   4. 
      
   
   

   

   NAC 500 mg Capsules. Take three to four times daily with lots of water

   
   
   
   

   

   Guaifenesin 400 mg Tablets. Take four times, daily

   
   

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References:

1. Centers for Disease Control and Prevention (CDC). (n.d.). Pertussis (whooping cough). Retrieved January 2025, from https://www.cdc.gov/pertussis/index.html

   Florida Department of Health. (n.d.).

2. Pertussis (whooping cough). Retrieved January 2025, from https://www.floridahealth.gov/diseases-and-conditions/vaccine-preventable-disease/pertussis/index.html

3. Journal of Pulmonology. (2024). Unraveling the resurgence of pertussis: Insights into epidemiological trends. Pulmonology, 253(10), 123-130. Retrieved from https://www.journalpulmonology.org/

4. Newsweek. (2024, November 10). Whooping cough cases soar in the U.S.: Tracking the resurgence. Retrieved from https://www.newsweek.com/pertussis-whooping-cough-cases-map-locations-2006367

5. CIDRAP. (2024, December). US whooping cough cases soar as public awareness remains low. Retrieved from https://www.cidrap.umn.edu/pertussis/us-whooping-cough-cases-soar-public-knowledge-contagious-disease-remains-low

6. The Times. (2024, November 28). Vaccine plea as three more babies die of whooping cough. Retrieved from https://www.thetimes.co.uk/

7. JAMA Network. (2024). Advances in pertussis vaccine development: Moving beyond acellular vaccines. JAMA, 382(7), 453-460. Retrieved from https://jamanetwork.com/

8. American Academy of Family Physicians (AAFP). (2021). Diagnosis and management of pertussis in adolescents and adults. American Family Physician, 104(3), 186-192. Retrieved from https://www.aafp.org/

9. Centers for Disease Control and Prevention (CDC). (n.d.). Pertussis outbreaks: Strategies for control. Retrieved January 2025, from https://www.cdc.gov/pertussis/outbreaks/index.html

10. World Health Organization (WHO). (2023). Pertussis vaccines: Global recommendations and implementation. WHO Bulletin, 101(8), 569-575. Retrieved from https://www.who.int/

11. Mayo Clinic. (n.d.). Whooping cough (pertussis): Symptoms, treatment, and prevention. Retrieved January 2025, from https://www.mayoclinic.org/

12. National Institute of Allergy and Infectious Diseases (NIAID). (2023). Research on pertussis immunity and vaccine development. NIAID Report, 45(6), 30-37. Retrieved from https://www.niaid.nih.gov/

13. Vaccine Hesitancy Research Group. (2023). Addressing vaccine hesitancy in the context of pertussis outbreaks. Journal of Vaccine Studies, 12(4), 211-218. Retrieved from https://www.journalvaccinestudies.org/

14. European Centre for Disease Prevention and Control (ECDC). (2023). Monitoring pertussis resurgence in Europe: Challenges and strategies. ECDC Bulletin, 15(7), 87-94. Retrieved from https://www.ecdc.europa.eu/

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David S. Klein, MD FACA FACPM

David S. Klein, MD, FACA, FACPM

1917 Boothe Circle, Suite 171

Longwood, Florida 32750

Tel: 407-679-3337

Fax: 407-678-7246

www.suffernomore.com

David S. Klein, MD Functional Medicine Physician