Whooping cough, which once caused 200,000 illnesses in the United States annually, all but disappeared in the late 1940s thanks to a vaccine.

But this year, three Southeast Texans - two in Jefferson County and one in Jasper County - have been diagnosed with the disease.

"It's a huge problem in Texas," said Cindy Powers, infection control practitioner at Christus St. Elizabeth Hospital.

Whooping cough has spread throughout Texas, killing four children and infecting 766 people this year, marking the highest number of cases since 1968, when 802 cases were reported.

The illness has been on the rise in the United States for several years, Texas Department of Health doctors said.

The disease spread because children are not being immunized, some experts say.

However, others say the vaccine wears off after about 10 years and leaves people unprotected.

Although adults are susceptible to whooping cough, children are most at risk, health officials say. Infected adults can bring the disease home to baby brothers and sisters.

About 30 percent of this year's cases have been children younger than a year.

Health officials said the end of summer vacation and start of school could accelerate whooping cough's spread.

"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," said Sharilyn Stanley, Texas Department of Health associate commissioner for disease control and prevention.

Whooping cough can 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, according to TDH officials.

Whooping cough, or pertussis, is a bacterial respiratory illness spread from person to person through coughing and sneezing.

Immunization is through a series of four primary vaccinations 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 a booster dose at 4 years. Protection increases after each dose. The vaccine is not authorized for people 7 and older.

The vaccine is about 80 percent to 90 percent effective, said David Bastis, TDH immunizations division program director.

The TDH is advising physicians to consider giving antibiotics immediately to patients with whooping cough symptoms instead of waiting on a lab confirmation of the disease. Family members also should be immunized.

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.

The second stage, typically lasting from one to six weeks, includes 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 breathe, 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 months.

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, officials said.

"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 Stanley of the TDH.

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

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