As a whooping cough epidemic hits California, you may be asking yourself, “hey, weren’t we all vaccinated for that?” Even as the headlines imply a Victorian-level outbreak of hacking and coughing, perhaps you’re looking around and wondering where, exactly, this epidemic is located. And what you should know about whooping cough to protect you and yours.

Here are some fun, weird, and sometimes worrying tidbits to know about whooping cough. Pass them on to friends and co-workers – because an epidemic of knowledge is a good thing to spread around:

1. Hey, you got vaccinated, and your kids did too – doesn’t that mean you’re protected? Um, no. Pertussis (the medical name for whooping cough) vaccines are actually kind of puny, and don’t last that long. Strange, but true. The original pertussis vaccine schedule was designed to protect the most vulnerable – the very young.

So, to get a good baseline level of protection, your baby gets many pertussis shots, one after the other. But even after a solid start of many boosting shots, the pertussis vaccines are only effective for most people for about 5 years. That’s why your kid gets another booster around kindergarten. So before recent changes in recommended vaccinations, most of us lost our solid baby-hood protection around age 10-11. Hence the recent outbreaks. But now, because of outbreaks that are appearing across the country, the CDC has recommended that a pertussis shot be included in every tetanus booster given to every adult. Without it, even if you had a documented case of the disease, your immunity will gradually disappear.

2. I’ve never heard anyone whoop in my entire life. So how can “experts” say there’s whooping cough breaking out all over? Fact is, you don’t have to whoop to have whooping cough. Here’s what the misery and classic sound of whooping cough sounds like. The “whoop” happens when the infected person desperately tries to inhale at the end of a truly miserable bout of uncontrollable coughing. The classic “whoop” sound is believed to be more common in a person who got no vaccinations, or only one as a baby, or has lost all their immunity. Partial immunity seems to mean that people get milder versions of what is, really, a hideous infection. What’s more, the whoop occurs way late – after days to weeks of sickness, as the coughing seems to get relentlessly worse. Pertussis can be found by medical tests, so disease-trackers, even without the whoops, can know who’s getting it, and where.

3. I’m supposed to take antibiotics for a runny nose? You’ve got to be kidding me. Whooping cough has a strange and nasty presentation, one that seems designed to fake out everything you’ve ever been taught about how to deal with colds and flu. It begins with a typical runny nose. Then (sneaky sneaky), the runny nose seems to go away after a few days. The cough begins, but it’s not so horrible at first. Kind of like what you’d expect from a typical, seasonal upper respiratory infection.

But then, right when you think you should be getting better, the spasms of coughing begin. We’re talking whole-body, snot-running-down-the-face, have-to-leave-the-meeting, holding-your-side, unable-to-catch-your-breath nastiness. These bouts will gradually worsenover time, striking at any moment, often at night, leaving a healthy person bent over, drenched in sweat and gasping. For many many people, this type of coughing hell leads inevitably to vomiting. Even in a hallway of the office, even on a street corner. It’s that involuntary. And, it goes on and on. For weeks and weeks. That’s what it’s like a normal, healthy person. Imagine how this type of thing can affect someone with a touch of emphysema. Or a frail set of chest muscles. Or a frail set of chest muscles. Or a tiny, too-young-to-be-vaccinated baby. People can indeed die from it, or from the pneumonia that you can get on top of it.

4. Won’t my doctor know if I’ve got whooping cough? Somewhere around weeks two or three, if you despair and go to the doctor, a typical exam will show … nothing. Even a really good doctor is likely to send you home with an inhaler (even if you don’t have asthma) and tell you to try using it to see if the inhaler will “break” the coughing spells. But only a doctor who’s aware of pertussis outbreaks and takes the time to listen to all your symptoms and how long they’ve been going on will recognize that what you have is probably whooping cough. Sadly, there’s no medicine to stop pertussis once it’s truly set it.

Taking the antibiotics for whooping cough after you’re had it for a couple of weeks (which is when most people drag themselves into see the doctor) does nothing. If you diagnose pertussis in the first week, taking the antibiotics then may reduce how long you are infectious to other people. But, keep in mind, there’s hope for the people you know and love! If a person is exposed to a true case of pertussis, and starts to have the runny nose stage – then, if you take the appropriate antibiotics in the first 72 hours, you can nip the whole nasty disease in the bud, right there and then (although a recent review of the few studies to support this practice resulted in an “insufficient evidence” to completely verify it works).

So you heard it from me, and I’ll back you up – there is, indeed, despite everything you’ve ever been told by every doctor your entire life, one and only time in medicine when it truly is appropriate and useful to take antibiotics for a runny nose. To kill off whooping cough before it begins.

5. What do you mean, I should get a tetanus shot if I’m a smoker? That’s just crazy. Well, no. Not any longer. Anyone who’s a smoker, anyone with lung disease of any kind, anyone with breathing troubles for any reason – you’re exactly the person who wants to be sure to stay up on your tetanus boosters. Because now, with the recent whooping cough outbreaks, your garden-variety tetanus booster comes with a pertussis booster added on! If you’re in a risk group of any kind, you don’t want to let your whooping cough immunity lag.

Jan Gurley is an internal medicine physician who blogs at Doc Gurley.

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