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The Texas Department of Health (TDH) and local health departments are focusing on protecting infants as they continue to battle a surge in the number of whooping cough cases around the state.

"Parents should keep infants away from people who have coughs or cold-like symptoms and should make sure infants and other young children are vaccinated against whooping cough," said Sharilyn Stanley, M.D., TDH associate commissioner for disease control and prevention.

Some 378 cases of whooping cough, including four infant deaths, have been recorded in 41 Texas counties so far this year. About 30 percent of all the cases have been in children under a year old.

Stanley said any infant with a cough or difficulty breathing should be seen by a physician.

Of the state's 378 cases of whooping cough, 86 have been in Burnet County, 54 in Travis County; 41 in Dallas County; 33 in Bexar County; 21 in Tarrant County, 18 in Williamson County, 15 in Hidalgo County, 14 in Cameron County and 13 in Harris County.

In lightly populated Burnet County, with 86 cases in a population of only 40,000, health officials have been battling a continuing outbreak of whooping cough that began in May. The Central Texas county includes Marble Falls and Burnet. No cases were reported in the county last year.

Stanley said the end of the summer vacation period and mid-August start of Texas school sessions could accelerate the spread of the illness.

"We're concerned that older students returning from camps and other gatherings in other parts of the state may bring whooping cough back to their schools, families and communities, and we're especially concerned about them transmitting it to their baby brothers and sisters," she said.

"Given that a lot of kids don't cover their mouths and noses when they cough or sneeze, the risk of transmission in school is increased," she explained.

She said older children, teen-agers and adults usually have milder cases of whooping cough but that it's more likely to cause pneumonia, seizures, brain damage and death in infants. The elderly and persons with weakened immune systems also are more likely to have severe complications.

Whooping cough, also called pertussis, is a bacterial respiratory illness spread from person to person through respiratory droplets from coughing and sneezing. The illness is most likely to be spread in household situations where opportunities for continual close contact with an infected family member are greater.

Complete vaccination against pertussis includes a series of four primary doses and a fifth booster dose of DTaP, a combination vaccine that also protects against diphtheria and tetanus.

The first dose should be given at 6 weeks to 2 months of age, with subsequent doses at 4 months, 6 months and 15-18 months, and the booster dose at 4 years. Protection increases after each dose. The vaccine is not authorized for people 7 and older.

She said TDH is advising physicians to consider giving antibiotics immediately to patients with whooping cough symptoms and to their family members, instead of waiting for results of lab tests to confirm the illness.

Noting that the vaccine's effectiveness may diminish after a few years, she added that physicians should not rule out whooping cough as a possible diagnosis simply because the patient has been vaccinated.

Whooping cough has three stages. The first is marked by a runny nose, sneezing, low-grade fever and a mild cough and usually lasts for one to two weeks.

prolonged spasms of rapid coughs usually accompanied by high-pitched whoops as the person gasps for air. Vomiting often follows the coughing fits. Sometimes apnea, a failure to breath, occurs. People usually feel fine between coughing bouts.

In the third stage the coughing spells occur less frequently as the patient recovers over a two- to three-week span, but coughing spasms can recur for several months.

"One of the biggest problems in controlling the spread of whooping cough is that it's often not suspected or diagnosed in the first stage when the symptoms are so similar to those of colds and allergies," Stanley said.

"It's usually not until the second stage, with the trademark coughing spells and whooping, that diagnosis and treatment occur. But someone with whooping cough can infect others throughout their illness," she said.

The incubation period, or time from exposure to the appearance of symptoms, is typically seven to 10 days but can range from four to 21 days and longer.

People who have had whooping cough are not likely to have it again.

Last year some 615 cases of whooping cough were reported in 70 Texas counties, the highest number of cases since 1968 when 802 cases were reported. The illness has been on an upward trend in the United States for several years.

For more information contact David Bastis, TDH Immunizations Division, at 512-458-7284; or Doug McBride, TDH Press Officer, at 512-458-7524.