From First Cold To Grave: How Two-Month-Old Brady Died Of Pertussis

Brady Alcaide, of Chicopee, Mass., died at two months old of pertussis.

Brady Alcaide — a happy, healthy six-week-old baby — got his first cold shortly after the new year.

His mother, Kathy Riffenburg, had seen her share of sniffles (she has two older daughters, 8 and 5) and didn’t think much of it. “It was just a little cough and sneeze,” she said. “I wasn’t too worried.”

But a few days later, on January 6, Brady’s fever spiked to 104 degrees. So, in the middle of the night, Riffenburg and her husband Jonathan decided to take the baby to the emergency department at Baystate Children’s Hospital in Springfield, Mass. near their home in Chicopee. Brady tested negative for flu and a common respiratory virus. By early morning, his fever was gone and the family was sent home.

Three weeks later Brady would be dead, a victim of pertussis, or whooping cough, a preventable but highly contagious bacterial disease that has been on the rise in recent decades.

At home, Brady’s breathing became slightly more labored; he’d been diagnosed with bronchiolitis, a swelling and buildup of mucus in the tiny air passages of the lungs, usually due to a viral infection. After another examination later in the week, a pediatrician prescribed albuterol to ease Brady’s symptoms.

On January 16, the Martin Luther King Jr. holiday, Brady started spitting up more and his breathing worsened. This time he was admitted to Baystate’s pediatric ICU, his mother said. A medical team assessed him; and an infectious disease doctor suggested he might have pertussis, though the diagnosis remained uncertain. Indeed, the family didn’t get confirmation of Brady’s pertussis until after his death, when a test for the disease came back positive. “I could have bet my whole life that it wasn’t pertussis,” Riffenburg said, recalling her reaction when the illness was first mentioned. “He wasn’t coughing like I would have imagined. And I didn’t know any infant who ever had pertussis.”

But pertussis, or whooping cough, or “the cough of 100 days” for its generally long duration, has been on the rise since the 1980s, according to the U.S. Centers for Disease Control and Prevention. The disease is characterized by violent, uncontrollable coughing (including the characteristic “whoop” sound) that can make it hard to breathe. But sometimes there is no “whoop.” And infants with pertussis don’t always cough, but may have apnea, a long pause in their breathing. The disease is most common in young children; babies under one are particularly vulnerable and face the greatest risk of death.

In 2010, there were 27,550 reported cases of pertussis nationally, the CDC says. That year, in California, 9,143 cases of pertussis — including ten infant deaths — were reported, the greatest number of cases in 63 years, according to the CDC. Vermont had a pertussis outbreak last year. And on April 3, Washington State officials declared a pertussis “epidemic,” with over 1,000 cases reported.

The CDC recommends pertussis vaccines for infants, adolescents and adults (most recently, pregnant women), summarized here:

Infants and children are recommended a dose of DTaP (Diphtheria, Tetanus, and Acellular Pertussis) vaccine at 2, 4 and 6 months, 15 through 18 months, and 4 through 6 years of age. Everyone 11 years and older, including pregnant women, is recommended one dose of Tdap (combined Tetanus, Diphtheria and Acellular Pertussis) vaccine, preferably at 11-12 years of age. Pregnant women are recommended to receive a dose of Tdap vaccine, preferably during the third trimester or late second trimester (after 20 weeks gestation). By getting Tdap vaccine during pregnancy, maternal pertussis antibodies transfer to the newborn, likely providing protection against pertussis in early life, before the baby starts getting DTaP vaccines. Tdap will also protect the mother at time of delivery, making her less likely to transmit pertussis to her infant.

A CDC spokesperson adds: “Everyone needs Tdap vaccine as an adolescent/adult even if they were fully vaccinated with DTaP or DTP vaccine as a child.”

What, exactly, is driving the increase in pertussis cases isn’t totally clear. Experts speak of a convergence of factors, including waning immunity after vaccination, low vaccine compliance among adults (who had coverage rates of only 8.2 percent in 2010, according to the CDC) and a general perception that whooping cough isn’t a dire condition. Another factor may be that pertussis is going undiagnosed in many cases — since not everyone “whoops” — allowing for disease to spread. In addition (though the CDC disputes this) declining use of antibiotics by doctors wary of overuse and drug resistance may also be a cause.

Some put the blame on parents who refuse to vaccinate their children. But officials at the CDC say it’s more likely that declining protection in vaccinated people rather than vaccine refusal is contributing to the increase.

(CDC)

At first, Brady (who was scheduled to have his first immunizations, including the vaccine for pertussis, on January 27) began to improve — the hospital staff even moved him to a room with three other roommates. After eight days in the hospital, Brady started a course of antibiotics; and a formal pertussis test was conducted, his mother said. He was then moved back into a single room.

That’s when things got really bad. On January 23, doctors inserted a breathing tube; on the 24th they changed his ventilator. “His CO2 levels are on the high side,” Riffenburg wrote on her Facebook page, where she had been updating far-flung family members.

Kathy Riffenburg's Facebook page with updates on Brady. (Courtesy of Kathy Riffenburg)

It became harder to keep Brady stable, she said, so on January 26 two new doctors were brought in to assess him. Within hours, one of them said the boy had to be rushed to Boston Children’s Hospital because Baystate didn’t have the necessary equipment to handle Brady’s deteriorating condition. Unable to fly to Boston from western Mass. due to weather, the family was left to travel by ambulance. Riffenburg said it took three hours to stabilize her son for travel and staff told her he had a 50-percent chance of surviving the 90-mile trip. A priest finalized a rushed baptism as Brady entered the elevator en route to the ambulance.

He almost didn’t survive the road trip. At exit 11 off the Mass. Turnpike, just outside Boston, Brady stopped breathing and his heart rate declined, Riffenburg said. A Children’s Hospital team met the ambulance on the highway and started doing compressions on the baby until they pulled up to the hospital where surgeons were waiting.

Doctors were able to get Brady on the heart-lung bypass machine, but by this time, his brain had already been deprived of oxygen and it was unclear how much damage was done.

Early in the morning of January 28, Riffenburg took a shower and rushed to Brady’s room. “He was very still — and he was puffy, very red. His foot was purple — it didn’t look like him,” she said.

After several long, hard discussions about Brady’s lack of substantive brain activity and the increasing difficulty of sustaining his blood pressure, a decision was made to take him off the machines. “We went into a room, said a couple of prayers, annointed him with oil and at 2:53 they pronounced him in my arms,” Riffenburg said. “I had to say goodbye to my baby. Then we had to go home that night without our son; we had to tell our girls what had happened and that Brady wasn’t coming home.”

Now, the family hopes to raise awareness about the dangers of pertussis through a site they created called Brady’s Cause. They want to reiterate the importance of childhood vaccinations, and in particular, tell every adult they know to get the vaccine. “A lot of adults, we don’t think about that,” Riffenburg said. “My husband was saying, when you have a newborn baby, you’re so caught up in the moment, if no one tells you to get a vaccine, you just don’t think of it.”

Riffenburg, a 29-year-old counselor at an after school program for kids, does not know how Brady contracted pertussis. Though most infants who develop the disease get it from an older child or adult in the family, everyone in Brady’s immediate family tested negative, she said. (Riffenburg and her daughters had been vaccinated; their father wasn’t but now is.)

Because pertussis is a preventable infectious disease, the state Department of Public Health has launched an investigation to try to pinpoint exactly where and how Brady got infected and if appropriate, provide treatment. John Jacob, a spokesman for the agency, says that since 2006 the state has reviewed 281 cases of pertussis in infants and of those, the source has been determined in about 65 percent of the cases. (Of the cases identified, family members were most often the source, he said. That’s why public health officials are pushing the concept of “cocooning,” that is, making sure all of the people around the infant are immunized.)

But Riffenburg said the state health investigator assigned to her case isn’t terribly optimistic about finding the source. “She said there is no way we will ever know where Brady contracted whooping cough.”

(Courtesy of Kathy Riffenburg)

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  • Bethany Alyssa Rowe

    I’m so sorry this happened. My condolences to this family.
    and to all the snide, rude, unnecessary comments from people who obviously need to be taught a lesson on when to keep their mouths shut, your opinions are invalid to anyone bc obviously you have never experienced your child getting whooping cough. How would you handle the situation? You wouldn’t be able to do anything any different than how this family did.

  • Eileen Geoghegan

    DO NOT blame this family for not vaccinating their baby, Brady was too young to be vaccinated for pertussis.

  • Jessica Powell

    I just lost my daughter to a variety of illnesses, starting with the coronavirus- which she some how contracted in the nicu and led to us calling 911 a week after she came home. She ended up with DIC, needed blood and plasma transfusions, and went septic before her organs shut down. We also had to make the decision when to have the drs stop chest compressions and take her of the manual ventilator. Too much blood and so much suffering for a little girl…. and I feel it could have been avoided. My heart breaks for your family as I know this pain of losing a baby all too well.

    • disgustedtaxpayer9

      So sorry for the loss of your precious child, and the traumatic experiences you all suffered with her series of illnesses. So sorry.

  • Ana_900

    My condolences to the family.

    I am not a big fan of rushing to get all the vaccines done however, my kids pediatrician highly recommended to rush on the Pertussis vaccine because he told me that he has seen some babies who got the disease and it way very disturbing. And I did, and I want to Thank him for convincing me. The rest of the vaccines were done but when are 4 vaccines at the time, I asked to have 1-2 and in 2 weeks the rest.

  • mplo

    i’ll start by giving my condolences to the family of the deceased baby, and, despite not knowing them personally, my thoughts are with them at this difficult time.

    One doesn’t have to be a mother (and I’m not!) to realize the consequences of not getting a child immunized against horrific communicable childhood diseases such as pertussis, tetanus, diphtheria, tetanus, polio and other such illnesses. What’s really disgusting about the Anti-Vaccine people is that they think that it’s all good and acceptable to manipulate parents into not vaccinating their kids due to the fear of something that was debunked and tossed out by the wayside years ago; the so-called, albeit fraudulent link between vaccines and autism, which, imho, is beyond wrong; it’s unconscionable.

    I’m one of the biggest free-speech advocates on Planet Earth, but I think that those anti-vaccine people have to be stopped in their tracks before they cause more heartbreak, death and disability to both children and their families alike.

  • LB

    I had whooping cough last year, after being vaccinated as a child. It was horrible and the cough felt like my head, heart and lungs might explode. I went to the doctor but they diagnosed it as a cold..this was before the cough came on. I got it from young kids, who were vaccinated but still contracted a slight case. Doctors need to be more aware of this disease. I can see how it could kill. I believe the upswing is due to both the young not being vaccinated and the older loosing their immunity.

  • adarc

    My son contracted Pertussis (Whooping Cough) in the 1st grade. He was sick for months. My mom knew exactly what it was, but his doctors were not convinced, calling it allergies, bronchitis, asthma – not until we saw a doctor at Children’s in Boston who had recently been in India treating a pertussis oubreak did we get the right diagnosis – too late for antibiotics to help at all. He was sick for the full 100 days advertised. I got the disease two years later, and have had asthma ever since. It is nothing to fool with.

  • lilai

    kinda relived for family that they don’t have burden of knowing they gave their baby the disease he died from (family tested neg for pertussis)

  • lilai

    I just wanted to WAIL with this family.
    Hard not to second guess but WHY WAIT SO LONG to go to Boston Children’s.? So long that he had only 50% chance surviving the trip?
    WHY wait so long to give antibiotics? ( 8 days?) you can give them prophelacticaly. Now I am open to there being ligit reasons but writer needs to include them in discription otherwise we are left thinking WHY

    • adarc

      Have you tried to get antibiotics for your kid lately? Your kid has to have a cough for at least two weeks to even be considered. Unfortunately antibiotics only work against Pertussis BEFORE the cough develops, at which point, it looks just like the common cold.
      No pediatrician (or doctor) gives antibiotics prophylactically anymore because that practice has led to the development many of our so-called super-bugs.

      • ROTELLO47

        or so they say. That policy has consequences obviously, and bacterial resistance vectors seem unimpressed.

      • disgustedtaxpayer9

        Yes, so they say. The experts never address the affect of not making sure antibiotics are given for a long enough course, and that there is follow up to make sure the patient is WELL before discontinuing. Shoddy care. Seems like here they never did anything prophylactically — in a tiny infant, just too the most minimal steps possible, assumed the least bad diagnosis and hoped for the best! Now baby is dead.

  • Earl

    choices. decisions. confusion. i found i was 6 weeks pregnant about two weeks ago. it was very unplanned with fiancee who who is told me he is fed up of me. after talking with my sister and friends, i decided to keep my baby. But i cant do it alone. Though i love my fiancee, he left me because of another woman. 5days ago i found a website were they talked about a spell lady who has helped several people on relations troubles and heart breaks. they placed her email there for anyone who needed her help. so i contacted the spell lady and she promised to bring him back to me in 2days. I never really believed but i gave it a try because i needed help at all cost. she did her spell and brought my man wilshere back to me yesterday. This is the most wonderful thing that has ever happened to me. I am now going to have my baby with the father by myside. The spell lady at priestess@yahoo.com is a goddess. thanks and so much love.

    • Gladys Cortez

      If you’re pregnant, EARL, you’ve got more to thank “the spell lady” for than you will EVER know.

      Now. Please stop spamming articles about ACTUAL problems happening to ACTUAL people with your FAKE garbage, and keep words like “goddess” out of your fake, spam-spouting mouth.

      • florinefrancis

        I second that Gladys!

  • barbara

    such a sad story. my condolences to the parents and family members of this little boy.

  • sara

    Omg that is horrible. Brought me to tears. As I have a 4 month old little boy. May Brady rest in peace. So terribly sorry for your loss

  • AKUA

    Your little angel was here for a moment, but he shall remain with us for a lifetime. From a mom of 3, thanks for sharing Brady’s story.

  • kinza

    I m so sorry for your loss…i dnt hv words to express…as a mother I cn just salute u for ur courage. May God bless lil brady…

  • ritadona

    My husband and I both had whooping cough about two years ago, but in both cases, the doctor said it was allergies! She even prescribed a steroid, which neither of us took. The coughing was worst at night and had us sleeping in separate bedrooms. I can’t imagine what a small child or infant must go through with this–or an elderly person. We don’t have children, though, so I figured that we must have gotten it from someone my husband works with who has kids.

  • Virgina

    That is so sad im sorry to here that

  • cath

    May God bless your family..

  • http://www.facebook.com/profile.php?id=1515324126 Heather Smith

    I am so sorry for your loss. I have a son that was born only 7 days earlier than Brady and I have been terrified of this disease since I found out I was pregnant. We live in Washington state where pertussis is crazy active and I thank God everyday for sparing my son. Though it may not seem like it God did have a reason for sending you Brady and just remember it was not God who stole him from you, but it is God who will take care of him until you meet again.

  • Madworld2012

    I am so so sorry to hear about this tragedy and my thoughts are with the family. He is beautiful.  I am curious if Brady was otherwise healthy, exclusively breastfed, and stayed in a non-smoking environment. If the story is to be shared with the public to raise awareness, complete information should be shared either way. Regarding the vaccine, many theorize the pertussis bacteria has evolved and the current vaccine no longer works–hasn’t worked for many years now (if it ever did).

    • bsis

      WRONG ABOUT VACCINE
      the many who “theorize” are Not scientists. They are not speculating this. The Pertussis vaccine has been changed in the last decade to make it safer. The new one has a lower efficacy rate. NO vaccine is 100% effective and that people think they are supposed to be is strange to me. You can research the effectiveness of vaccines. It’ s published. I have read that another reason that Immunity in the population at large has dropped is because the bulk of people who have HAD pertussis as children (used to be before 50s or ?early 60s kids got it so had lifelong immunity) are dying off. Used to be (say in 1970) bulk of population had immunity because they’d HAD pertusssis as kids.

      People FYI who ask questions like those you did often do to relieve themselves of worry…well my baby is safe because I breastfeed exclusively.. Those kinds of questions could hurt the grieving parents because they innadvertantly or not often seem to point a finger.

      Brady got Pertussis. Not from his family. FEW people smoke around newborns. I think if he had a comorbid illness or condition they’d have mentioned it in the article. As for breastfeeding, MANY American adult women are not vaccinated for pertusssis. If they are not immune they will not pass on passive immunity via breast milk (ie antibidies) to their infant anyway. This mother HAD had her booster. So it is true that if she breastfed Brady would have recieved some passive immunity from his mother. Whether it’d be enough to fight the onslaught of the disease is unknown.

  • Sue

    My heart breaks for this family. I am a 48 year old woman on day 50 of the “100 day cough.” I was diagnosed with whooping cough when after being sick for 4 weeks my respiratory cold symptoms would not go away. My lungs hurt and itched and were producing a lot of mucous at night, but would sound clear when I went to the doctor. I insisted on an xray and they decided to test for pertussis. It is uncomfortable and exhausting and I can’t imagine having this as an infant. Although I now understand that you can still get whooping cough even if you have been vaccinated, I do wish that my doctor had suggested that I get the Tdap booster, given that I haven’t had a tetanus shot in over 10 years. 

    • aiegp

      agreed. Your doctor did fall short. I’m annoyed that my own didn’t know or tell me about Tdap booster, I found out myself. THey should tell every adult patient when they have their physical. It’s very bad practice that they don’t. And my doc is with a “major Boston teaching hospital”

  • Amy

    Brady you will be missed so much.  May the angels always watch over you.  I am so grateful for all the hard work Kathy and her family have done to raise awareness.  I have a son around Brady’s age and I would not have know so much about Pertussis if it wasn’t for your family.  Thank you for protecting us.  We are forever grateful.  May God watch over your family and keep you safe always. My thoughts and prayers are with you and your family.

  • Hil

    You are fine people for opening up about your loss to try and save others. My heart goes out to you. May you find some peace in your quest to save others. Thank you for your efforts.

  • Dr. J Flores

    As a mom, this story is emotionally wrenching and my thoughts and prayers are with the family.  But, as a doctor, I feel there is much misinformation about pertussis out there – some of which has been posted here.  Pertussis is bacterial, but antibiotics are only effective before the cough or other severe symptoms begin.  The vaccine, while somewhat protective, is not fully protective.  Even people who have been recently vaccinated can get the disease, as I have seen in my medical practice.  And, the vaccine wears off over time, so those older children and adults who have not had boosters are at risk.  Please, get your Tdap booster if you are an adult!  And stop blaming parents who do not vaccinate their children – research has show this is not the problem!

    • http://twitter.com/perizade Perizade

      Can I ask a question? Why are you recommending that adults get their boosters but then saying that non-vaccinated people, albeit children, are not the problem? They may not be the driving force, but non-vaccination is part of the issue. Or at least, it soon will be if vaccine refusal continues to rise.

      • leilei

        you don’ t understand what she’s saying but think you do, that’s the issue. Vast majority of adults have not gotten booster (over 90% it says in article) but MOST KIDS HAVE.the number of kids who aren’t vaccinated are still few much fewer than adults who are no longer immune. Anyone with contact with infant MUST get (re) immunized or they risk killing that infant. They might have a bad cough and it turns out it’s pertussis (it is sometimes mild) and infant dies from it

  • mitch4chicago

    A tragedy for the child and parents.  A shame the story mentioned antibiotics in a story about a viral infection.

    • Rachel Zimmerman

      Hello Mitch4chicago –

      Thanks for your comment.  But in fact, pertussis is a bacterial disease, hence the mention of antibiotics, which Brady was ultimately prescribed.

      RZ

  • http://profile.yahoo.com/RAYSXCDPTVP7WHEOIERGZIS7LI B

    I’m so sorry . . . this is so very sad.

  • Kt Vanw

    “But officials at the CDC say it’s more likely that declining protection
    in vaccinated people rather than vaccine refusal is contributing to the
    increase.”

    That’s the crux of it right there – DECLINING PROTECTION IN VACCINATED PEOPLE.  I was a vaccinated adult who got pertussis anyway.  Wasn’t diagnosed til a month after symptoms began – it’s VERY difficult to diagnose pertussis, especially in adults.  It isn’t always present in a sputum culture.  Here’s the kicker – MY vaccination was current.  I was supposed to be covered.  But I wasn’t.  And now I have come to understand that vaccinations don’t always work effectively – 20% of the time they don’t work at all.  Of the 80% that is effective, it MAY be UP TO 100% effective for UP TO ten years.  Read between the lines.  It may be 50% effective for two years.  It may be 100% effective for five years.  It may be 75% effective for six months.  So how often should YOU get booster shots?  No one really knows.  The only thing they know for sure is that vaccines DELAY the onset of childhood diseases.  They do NOT protect you from them.

    • leigla

      why are you shocked? Most drugs (including vaccines ) ARE NOT 100% effective. Why did you think they ever were? Maybe this is a common misperception. Maybe it’s from our parents simplistically telling us when we are kids “it will keep you from getting sick”. ALL vaccines vary in effectiveness depends on vaccine and the disease and the immune system of the person getting it. Pertusis is NASTY if you can reduce your chance of getting it by more than half why not? And, if you get it even with booster (so you got adult booster? because the one we got as teenagers expires) likely you get a more mild case. You sound like you are complaining like someone lied to you. It is your OWN misunderstanding of how vaccines work.NO ONE EVER SAYS THEY MAKE EVERY SINGLE PERSON IMMUNE.

    • leigla

      they do not “delay’ oncet of childhood disease “not prevent them” that is an erroneous conclussion from what you discovered. MANY PEOPLE WILL NEVER GET PERTUSISS or measles or mumps. Most people, probably. You were unlucky. And after years, pubic health people do publish (you have to research it) what the effectiveness of various vaccines are. Did you know they CHANGED the pertussis vaccine in last decade? They made it SAFER but they did not kjnow (cannot) until many people had gotten it that it was Less effective than some vaccines, than the last vaccine. Safer thought. I’ll take the trade off thank you.

    • Phoo

      Vaccines work by the way that when more people are vaccinated it reduces the ability of the disease to spread. Yes, it is not 100% effective but it is more effective when a high percent, usually around 90% of the population, is vaccinated. 90% of adults are unvaccinated. So, you are at higher risk.

  • TuSA23

    Oh that poor little baby :( I feel so sorry for him and his family. 

    But, I have seen more and more families deciding not to get their children vaccinated. Talk about first world problems! There are people in other countries begging for these vaccines and other basic forms of medical care and yet we have people in this country deciding not to vaccinate. Unbelievable. 

  • Jrebekah

    I am so sorry…I really feel for the family for such a tragedy…so pointless a death and sad.

  • Darcy-joy

    Very sad.  What are they doing about day care workers.  As far as I know, they are not required to have the pertussis vaccine and babies can enter daycare as early as 6 weeks old.

    • leele0g

      I was required to get one where I work. TB test also. Did you check into it as far as you know or you mean just offhand knowledge but you never really asked or looked into it?
      Requirements, FYI for adult booster are only about five yrs or less old.Before then they did not know we loose immunity

  • Maria Palumbo48

    Sorry about such a baby and a lost.  May the baby be at peace where ever they go from earth, i like to believe in Jesus’s Arms. My deepest sympathy for the mother, father and family. It is so hard to understand such a tragic occurance, short life but meanful. take care little baby.. your story grabs all our hearts. We cry for the lost of you …. bye

  • Franciesmama

    Heartbreaking. What a beautiful little baby. So sad. Condolences to the family. And thanks for raising public awareness of pertussis. Good to know.